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02/1:12013 14:13 FAX 9529335049 CULLIGAN MNTKA lj004 <br /> • <br /> i <br /> J.,i''.x 'p ',R• � o � r`� roc r,�q' '°` �? v � i <br /> If above does not apply;fol ow guidelines below: <br /> 1. 'CO PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> x.0125$ <br /> (contract price) (minimum 350.00) <br /> 2. STATE SURCHARGE **Add the State Bldg Code Div.Surcharge(Minimum Fee of S5.00) <br /> x.0005 $ <br /> (contract price) (minimum S 5.00) <br /> 3. POS AGE I HANDLING(Only on Mail-In Applications) $ 2.00 <br /> • <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ c3 a , 6 0 <br /> • * COIN ACF 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 /> ■ **1l'he ESTATE 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 the Building Department at(952)249-4600 for the price. <br /> •,4,.fI�.Dti 4A-!I4Al.,,.4:`k4I'2.�. C'F��. 'rti .. .�y.;s, S E, <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: Date: a pg ' 13 <br /> ,3 <br /> il?7, <br />