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Apr. 18. 2016 11 : 25AM Genz — Ryan No, 0477 P. 2 • FIXTURE BSMT 1ST 2ND OTHER FIXTURE BSMT 1ST 2ND OTHER TYPE Floor Floor TYPE Floor Floor Water Closet Floor Drains Lavatory 'j Sewer Ejector Bathtub , Laundry Tray Shower Washer Kitchen Sink Water Heater Disposal Water Softener Dishwasher Wet Bar Sillcocks Miscellaneous 1. CONTRACT PRICE * is 1.25% of contract price with a (Minimum Fee of$50.00) 4 D- oo x.0125 $ . .OD (contract price) (minimum$50.00) 2. STATE SURCHARGE V)O.(D x .0005 $ °- 2S (contract price) 3. POSTAGE & HANDLING (Only on Mail-In Applications) $ 2.00 4. TOTAL PERMIT FEE (Add Lines 1-3 Above) $ 4 c, 2S * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted work including materials, labor, profit, and other fixed costs. It is the amount to be charged to the customer for the work done. If any material, equipment, labor or installations are furnished by the owner, tenant or any other party, the reasonable market value of such items must be added to the estimated cost or contract price for permit fee purposes. In the event that there is a dispute on the amount of the job cost, the City may request the submission of a signed copy of the actual contract. 'i:�ys';h;.,, ,.�.,,,M.,y,i ..:4'':S;Anpq, ,9•' -r.. rpt' 't.. .�. ,:, ,. ,. ..t:'�..:.,.i:t.,.::C;q,f,z;; '..';i' .,;�>,, •c' a• :'s" Y,i7'-U ' "t t,'A .a:iV '. 1... HIP TIO .AG'R�EI�f�1VY The undersigned hereby applies to the City for issuance of a Plumbing Permit, agrees to do all work in strict accordance with the ordinances of the City and the regulations of the State of Minnesota, and certifies that all statements made on this application are complete,true and correct. Applicant's Signature: Date: 14I 12I I Building Official/Inspector: Date: Page 2