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Sep 271711:24a Legend Services Inc 763-479-6003 p.3 <br /> PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT I 18T 2ND OTHER 1 FIXTURE BSMT 13T 2ND OTHER <br /> TYPE Floor Floor TYPE Floor Floor <br /> Water Closet I I 3 Floor Drains 1 <br /> Lavatory I I H Sewer Ejector <br /> Bathtub ! 3 Laundry Tray I j <br /> ShowerI Washer <br /> Kitchen Sink I 1 Water Heater i <br /> Disposal ( I Water Softener <br /> Dishwasher I -(``� i / Wet Bar f <br /> Sillcocks ‘)- Miscellaneous <br /> PERMIT FEE CALCULATION <br /> 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> 2 /1 400 x .0125 $ .).6.A , sc <br /> (contract price) (minimum $50.00) <br /> 2. STATE SURCHARGE <br /> a r +?c9 a x.0005 $ <br /> /0. 5-O <br /> (contract price) <br /> 3. POSTAGE&HANDLING (Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE (Add Lines 1-3 Above) $ A 73 <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the <br /> permitted work including materials, labor, profit, and other fixed costs. It is the amount to be charged to <br /> the customer for the work done. If any material, equipment, labor or installations are furnished by the <br /> owner, tenant or any other party, the reasonable market value of such items must be added to the <br /> estimated cost or contract price for permit fee purposes. In the event that there is a dispute on the <br /> amount of the job cost, the City may request the submission of a signed copy of the actual contract. <br /> PLUMBING PERMIT APPLICATION AGREEMENT <br /> The undersigned hereby applies to the City for issuance of a Plumbing Permit, agrees to do all work in <br /> strict accordance with the ordinances of the City and the regulations of the State of Minnesota, and <br /> certifies that all statements made on this application are complete, true and correct. <br /> Applicant's Signature: t 'ge iwflei, Date: 9 7-/ 7 <br /> Building Official/Inspector: Date: <br /> Page 2 <br />