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03/15/2018 THU 14: 53 FAX 763 473 8565 Sabre seating & Air Cond Q003/006
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<br /> FIXTURE BSMT 18T 2ND OTHER FIXTURE BSMT 1ST
<br /> 2"D OTHER
<br /> TYPE Floor Floor TYPE Floor Floor
<br /> Water Closet ( -2- Floor Drains
<br /> Lavatory 2 3 Sewer Ejector
<br /> Bathtub _I_ Laundry Tray I
<br /> Shower 1 Washer 1
<br /> Kitchen Sink Water Heater j
<br /> Disposal ' Water Softener
<br /> Dishwasher Wet Bar
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<br /> Sillcocks 2- Miscellaneous
<br /> 'j'T- i(,i,7 ftp b �:�f �LLI..T.�,`�Ir� VDP77. 7 "
<br /> 1. CONTRACT PRICE " is 1.25%of contract price with a (Minimum Fee of$50.00)
<br /> 15011. Lig x.0125 $ 1$1,1' )
<br /> (contract price) (minimum$50.00)
<br /> 2. STATE SURCHARGE
<br /> 15a 2i 4 x.0005 $ 151
<br /> (contract price)
<br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00
<br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ 19/.2Z
<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.
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<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: ti1r. 4.4.444.1d4Date: 3 •/5 ZI)iK
<br /> Building Official/Inspector: _ Date:
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