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04/19/2016 10:33 FAX 9529335049 CULLIGAN MNTKA 0016 <br /> ol� N✓` . r tt �T, 'VT $w), :01 �i Lys +?.e�Cr�!ii rrp„dr1 e'.'1Ca <br /> '��;�1r`�.a�i�, r"� �...�.a.' . d' .mJ:—^�'��� ��';d:7�nr'�P�.O,�UU!,;r�.. <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE w is 1.25%of contract price o iith a(Minimum Fee of 550.00) 0� <br /> 6 U x.0 1 25 5 <br /> ., )' -(contract pri (minimum$50.00) <br /> 2. STATE SURCHARGE **Add the State Bldg Code Div.Surcharge(Minimum Fee of <br /> x.0005 $ O <br /> (contract price) (minimum$ 5.00)2,11Q � .D / <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2, . 7�/ <br /> 4. TOTAL PERMJT FEE(Add Lines 1-3 Above) $ ' <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 SUkCHARGE is.0005 of the contract price under 51,000,000 or 55.00—whichever is <br /> greater. For valuations over$1,000,000 call the Building Department at(952)249-4600 for the price. <br /> , `A.kl` r7MNi $004061M'-:: .4):1,''.,i' n�r7fa'i: _4 a FM <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 /> 41 <br /> Applicant's Signature; ~ Date: q , 1 ck)(N <br /> iii�r .oto de;w±hi' <br /> ;l,,i.r%41.N' q611 <br /> • <br /> 3 <br />