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12/11/2014 14:00_FAX 9529335049 CULLIGAN MNTKA J 004 <br /> - T,1 ,-jai h T—'r' N'aNt <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> x.0125$ <br /> (contract price) (minimum$50.00) <br /> 2. STATE SURCHARGE **Add thc State Bldg Code Div.Surcharge(Minimum Fee of$5.00) <br /> x.0005 $ <br /> (contract price) (minimum S 5.00) <br /> 3. POSTAGE&HANDLING(Only on Mail-in Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ aa' 00 <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 <br /> to the customer for the work done. If any material,equipment, labor or installations are furnished by <br /> the 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 /> • **The STATE SURCHARGE is.0005 of the contract price under$1,000,000 or$5.00—whichever is <br /> greater. For valuations over$1,000,000 call they Building Departmentptat(952)2)24j9-4461000.for the} price. rya <br /> `,','1�' !'FX7'9•.NZi,�NP�r ; �S"t'" Y.tEl `''b Ot t •�V,.+�' riga'LLt+'x+a'a'J.'.al' 'i�k°,�N�iI?IirC�sai,'�06`:w.rbi: �^4+'�C''1. <br /> The undersigned hereby applies to the City for issuance of a Plumbing Permit, agrees to do all <br /> work in strict accordance with the ordinances of the City and the regulations of the State of' <br /> Minnesota, and certifies that all statements made on this application are complete, true and <br /> correct. <br /> Applicant's Signature: - J c-y"` Date: I a-- 0 - ( 7 <br /> or <br /> 3 <br />