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11/16/2010 15:31 FAX 9529335049 CULLIGAN MNTKA f�004 <br /> � • 4 <br /> ,•r,•" `"•r-�'v:t;�c� ' � �...,y,' .!�•j `, yn'r'.�:��i%:�';�•,i:� <br /> ri;;'�;. ��, � ��� �� T C� `'�' ':-� ,5`; ��►,'�.v �. :r�'.;�;i,�,,: <br /> .r. ';fT�`iu �?'�n { "' '{"' <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE '�is 1.25%of contract price with a(Mini um Fce of 550.00) <br /> x.O1Z5$ <br /> (contract price) inimum$50.00) <br /> 2. STA'I'E SURCHARGE "*Add the State Bldg Code Div.Surcharge(Minim Fa of S5.0o) <br /> x.0005 S <br /> (wnuact price) (minimum$ S. <br /> 3. POSTAG�&HANDLING(Only on Mail-In Applications) S Z. <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) S � � �V <br /> ■ " CONTRAC'f 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 W be charged <br /> to the customer for the work done. 1f any material, equipment,labor or installations are fumished 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 SURCHARGE is.0005 of the contract prica under�1,000,000 or��:�Ot�—whichever is <br /> grester. For valuations over$1,000,004 call the Building Departrnent at(952)249-4600 for the price. <br /> The undersigned hereby applies to tho City for issuance of a Plurnbing 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 /> correc� <br /> Applicant's Signahue: Date: � �' �b' �� <br /> 3 <br />