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• • �� � - - , _. _ ,fat ,."'r <br /> FIXTURE BSMT 1ST 2ND OTHER FIXTURE BSMT 1ST 2ND OTHER <br /> TYPE Floor Floor TYPE Floor Floor <br /> Water Closet ` 13 Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathtub 2 Laundry Tray <br /> Shower ( 2 Washer <br /> Kitchen Sink ( Water Heater <br /> Disposal Water Softener <br /> Dishwasher ' Wet Bar <br /> Sillcocks Miscellaneous <br /> 4P V5, e , £;3 <br /> 1. CONTRACT PRICE *is 1.25% of contract price with a (Minimum Fee of$50.00) <br /> 19)Sb0 x .0125 $ .4S <br /> (contract price) (minimum $50.00) <br /> 2. STATE SURCHARGE <br /> ,Lk 5 x .0005 $ 1 -LS <br /> (contrack price) <br /> 3. POSTAGE & HANDLING (Only on Mail-In Applications) $ }A)° . <br /> 4. TOTAL PERMIT FEE (Add Lines 1-3 Above) $ , coed <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 /> 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..0n this application are complete, true and correct. <br /> Applicant's Signature: Date: 2/4/7 <br /> Building Official/ Inspector: Date: <br /> Page 2 <br />