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PLUMBING.FIXTURES BEING INSTALLED . <br /> FIXTURE BSMT 1ST 2ND OTHER FIXTURE BSMT 1ST 2ND OTHER <br /> TYPE Floor Floor TYPE Floor Floor <br /> Water Closet a Floor Drains 3 a 5arMie <br /> Lavatory 3 3 Sewer Ejector <br /> Bathtub I Laundry Tray <br /> Shower a Washer I I <br /> Kitchen Sink A I Water Heater <br /> Disposal Water Softener l <br /> Dishwasher t Wet Bar <br /> Gree I <br /> Sillcocks 3 Miscellaneous bJner <br /> i t li;. .y to ?Z c, :':�, <br /> 1. CONTRACT PRICE * is 1.25% of contract price with a (Minimum Fee of$50.00) <br /> 95. 000,0'0 x .0125 $ 5 ..)a.50 <br /> (contract price) (minimum $50.00) <br /> 2. STATE SURCHARGE <br /> x .0005 $ Da,S 0 <br /> (contract price) <br /> 3. POSTAGE & HANDLING (Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE (Add Lines 1-3 Above) $ 5 B . 0 0 <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 /> ` y j`.i4i 1 r h. 2i, '�f"°Pi MBI N •AA O�• g Y MSIAr i ag?,,Y C...'• iY r4° <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 /> \i,.. �� Date: y"Z- <br /> Applicant's Signature: \ <br /> Building Official/ Inspector: Date: <br /> Page 2 <br />