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Feb 17 2817 12:80:33 Via Fay( -> 9522494616 Vonage Page 005 Of 008 <br /> 1 * <br /> 4:Sy p - 7:,:;ter <br /> �srs.'.::.w' w.,:......�;.w.`;_,.,.,., . .......:....•- ...µ•,'.:.,M.r:,n.:wew;r: . .chr - ,.r::"'m;•• -�-.. ,r'�r:+��`: t M <br /> —- <br /> FIXTURE BSMT 18T 2Np -. .�:.,,,`_ _ <br /> OTHER FIXTURE BSMT 1s' 2"° OTHER <br /> TYPE Floor Floor TYPE Floor Floor <br /> .{.,_ <br /> Water Closet I ( 3 Floor Drains i <br /> Lavatory 1 t rr Sewer Ejector <br /> Bathtub 2- Laundry Tray <br /> � <br /> �. <br /> Shower t I .. Washer a „ „ <br /> Kitchen Sink I i Water Heater ) <br /> Disposal, 11 Water Softener <br /> Dishwasher Wet Bar 4 <br /> Siticocks 7— fMiscellaneous <br /> 1. CONTRACT PRICE is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> 4 0 x .0125 $ ,, C <br /> (contract price) (minimum $50.00) <br /> 2. STATE SURCHARGE <br /> 4,.. I ` �y V •x..0005 $ /(. <br /> (contract price) <br /> 3. POSTAGE& HANDLING (Only on Mail-In Applications) $ 2.00 <br /> r <br /> y x <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) . $ ~~ - �� <br /> * CONTRACT PRICE or JbB COST means the actual or estimated dollar amount charged for the <br /> permitted work including m terials, labor, profit, and other fixed costs. lt:is the amount to be charged to <br /> the customer for the work one. 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 /> s. d <br /> ..:, .....,'c., .ar.;<.;;,. ....-.>,��,,..::v,,ren.:: w. OR:— TOPIACi <br /> € * <br /> The undersigned hereby aplies to the City for issuance of a Plumbing Permit, agrees to do all work in <br /> strict accordance with the olydinances of the City and the regulations of the State of Minnesota, and <br /> certifies that all statements.Made on this application, complete,true and correct. <br /> Applicant's Signature: <br /> r� ' <br /> PP 9 `� - '" ',i . Date: s7 ( - —, _.. <br /> Building Official/Inspector: Date: w . <br /> Pogo 2 <br />