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<br /> n;y, - S . . u m- J -.._.....,:-,-,.:1-. /..m..::,._u,.�u�r9n..,�CviL4.... .....t.'.1 ..._ o_..rJ..... nu4.......4�....r .. .+J_....:,.........
<br /> FIXTURE BSMT 191 2ND OTHER FIXTURE BSMT 1ST 2ND OTHER
<br /> TYPE Floor Floor TYPE Floor Floor
<br /> Water Closet , 2 Floor Drains
<br /> Lavatory k 7) Sewer Ejector
<br /> Bathtub Z. Laundry Tray 1
<br /> Shower r 1 Washer 1
<br /> Kitchen Sink \ Water Heater 1
<br /> Disposal 1 Water Softener
<br /> Dishwasher ' Wet Bar
<br /> Sil!cocks Miscellaneous
<br /> Fs� . _ ,-..!,—L,-2_.-__•
<br /> fir . � 1
<br /> � �A�x�.��., .�....:.�� .,. .,! 'a.�...i�_' r.i..Sf':r..m_a 3�_dr!l..f�_�.� �7,,T. 7-7-777.7----7-',,71-177� 11�� s i '] it � �..,.. 4 !.. yf � a -.4
<br /> '6''',.-
<br /> .. M � �.. �Ln <1 U.....r.L_.�_ .,...f_L �..!a -.$...�%�:5� kr_
<br /> 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00)
<br /> 150C) c)
<br /> x.0125 $ \ 5o• ' —
<br /> (contract price) (minimum$50,00)
<br /> 2. STATE SURCHARGE I
<br /> \ t 60 6 x .0005 $___ LP . 2_5
<br /> (contract price)
<br /> 3_ POSTAGE&HANDLING (Only on Mail-In Applications) $ --4:819-
<br /> 4.
<br /> ..019-4. TOTAL PERMIT FEE (Add Lines 1-8 Above) $ , lff7_ o 5 0
<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 /> --,-,--F---.77- r T
<br /> T. . ..-.;.:”.r1 71 .( f- 4 m,t.. y,. N r i _ {.- r•ar ,41,f_✓z3.>rt`4'11 v:47
<br /> . s _ «Er,4�dtrt i)., . .�...v >,. r'f .! •�,13 ti4 r.- ,�. 3T..-v.i''] -. �r t.!ti7 � i. i < wt I
<br /> ati. ,.
<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 ade on this appli • complete, true and correct. c�
<br /> Applicant's Signature: Date: 3) 1 3 1 ) O
<br /> Building Official/Inspector. .. Date:
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