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01/24/2017 11:43 FAX 9529335049 CULLIGAN MNTKA 1005 <br /> 1tIM B LF <br /> ING`FiXTIJR � ._ _ �� <br /> E$r'BEIN�::INScT�...� -C � . �:� Ztetd <br /> FIXTURE BSMT 1ST 2ND OTHER FIXTURE BSMT 1ST 2ND Floor Floor OTHER <br /> TYPE Floor Floor TYPE <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener I <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> �-,-- n 3 � 'M� ;,� x� � .Zg PERMITTEE�ALCUEA;T1.ONA r ..... .{. ..:k . . _ . <br /> VFI <br /> -fix.k-.� .�._. .�..,-. ..i� : _..,.. � <br /> 1. CONTRACT PRICE * is 1.25% of contract price with a (Minimum Fee of$50.00) , <br /> ,-7-u'6 x .0125 $ "-t„ <br /> (contract price) (minimum $50.00) <br /> 2. STATE SURCHARGE <br /> l <br /> x .0005 $ <br /> (contract price) <br /> 3. POSTAGE& HANDLING (Only on Mail-In Applications) $ 2.00 <br /> I _ <br /> 4. TOTAL PERMIT FEE (Add Lines 1-3 Above) $ 9 J <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 /> itte;tgatt#140,PIMM)31Nia:PERMirAPP.11,CAPOWAGKEMEIgrikattZON.PKA <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: L..._Q., r <br /> Date: i-cDM `-171 <br /> Building Official/Inspector: Date: <br /> Page 2 <br />