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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 1 ?� Floor Drains <br /> Lavatory 3 3 Sewer Ejector <br /> Bathtub I ) Laundry Tray <br /> Shower 1 a Washer <br /> Kitchen Sink 3 Water Heater 1 <br /> Disposal ( Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks 3 Miscellaneous <br /> PERMIT FEE CALCULATION 37 <br /> 1. CONTRACT PRICE * is 1.25% of contract price with a (Minimum Fee of$50.00) <br /> 410001-3 x .0125 $ <br /> (contract price) (minimum $50.00) <br /> 2. STATE SURCHARGE <br /> *CI C_Y4 x .0005 $ q�� <br /> (contract price) <br /> 3. POSTAGE & HANDLING (Only on Mail-In Applications) $ �0 <br /> 4. TOTAL PERMIT FEE (Add Lines 1-3 Above) $ 3d1109-5-- <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 ar: complete, true and correct. <br /> Applicant's Signature://r- _—.07:41/1" Date: <br /> Building Official/ Inspector: Date: <br /> Page 2 <br />