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�, PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT 1sT 2ND OTHER FIXTURE BSMT 18T 2N- v i t„. <br /> TYPE Floor Floor TYPE Floor Floor <br /> Water Closet a c9, Floor Drains 5 <br /> Lavatory ( Sewer Ejector <br /> Bathtub ` l Laundry Tray <br /> Shower ' A Washer <br /> Kitchen Sink ' Water Heater 1 <br /> i Disposal 1 Water Softener <br /> Dishwasher ' Wet Bar 1 <br /> Sillcocks 3 Miscellaneous <br /> PERMIT FEE CALCULATION <br /> 1. CONTRACT PRICE * is 1.25%of contract price with a (Minimum Fee of$50,00) <br /> ('11.--)V3, 0C) x .0125 $ .7 • 37 <br /> (contract price) (minimum $50.00) <br /> 2. STATE SURCHARGE <br /> `E 1 �� " —,J. Oo x .0005 $ 'Q. 8t� <br /> (contract price) <br /> 3. POSTAGE& HANDLING (Only on Mail-In Applications) $ 2.00 <br /> ,-- .0 <br /> 4. TOTAL PERMIT FEE (Add Lines 1-3 Above) $ vim)9 ', D cY/k1 , <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 /> PLUMBING PERMIT APPLICATION AGREEMENT <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.Alli <br /> l f <br /> A-)//11P/ <br /> or i <br /> Applicant's Signature* Date: 10--', .—/(,4 <br /> .+/' v�_....�r� <br /> Building Official/Inspector: Date: <br /> Page 2 <br />