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04-18—'18 13:39 FROM— T-811 P0003/0004 F-289 <br /> • � • � i <br /> , � <br /> ; <br /> � <br /> � <br /> PERMIT PEE CALCULATION(S) ; <br /> BASED�PF-2002 STAT�STATUE ' <br /> � <br /> ❑ Yes,this Section t+p��lies i <br /> I <br /> , <br /> The repinctmenr of,t Residentixl Fxture,or apJ7liaqce th�r meels All lhree oFtl�Follo��ri�ig rcquiremti�ts: � <br /> i <br /> t. 1'?�es not�eyuirr uiodificafion to clectrical ar gas service. E <br /> 2. �ies R I cost of$300.00 or less;excludin2 tlte cost of the fixtn��or appliAneer aEtd � <br /> 3, is improved,installtd or rcplaced by d�e lioiuea�vitei•or licensed conU�ctor. � <br /> Skip nest section,if d�is eppli�s; Cost of Aennit $ I5.00 � <br /> $tAtC SUTCI18C�6 S S.QO � <br /> Mail•In Fee(if Applicable) � ___?•09 � <br /> Total Periilil Fee S ( <br /> E <br /> pERMIT PEE CA,�.CULATION(S)—�O�S OVE�$500.00 ; <br /> ! <br /> If above does not npply;follow giiicleli�las belp��: � <br /> L CO�TRA.GT PR10E x is I?5%of c%� pxicc�vith a(lfinimurn ree of 350AD�� � <br /> �6 �' Z3 �� ' <br /> X.�ias s j <br /> (toolfBC�ptfCtl)' (mininikni S30.00) ! <br /> ?. ST,�iTCSURCEtr1RGE �� � g'�'I ; <br /> x AOOS S �^ ; <br /> `(coni?nct price) <br /> 3, POSTAGE R 1•IA\DL)�1G(Ouly on\I�il•In Applicntions) $. -2.OQ . f <br /> yy <br /> �4. TOTr�,L PGR111T P��(Add Lines !-3 Above) ��Qfr� � <br /> ■ "" COVTI�ACT PRICE or JOS COST iuenns the �cni�l or estimttt�d dollnr amau�t chnrged For tlu , <br /> p:rt)lilted�+•Ork iqClu�ling mNltrials,Inbor.pivfit,anc!otiier Fsed costs. (�is the amoimt to be ch8rgecl <br /> ro the custonur for lhc�►•ork done. ff an�•inateriaL cqulpment, tabor or inst�ll�tions flr�furuishecJ by' <br /> tlte onver,tcnnn[or nny ather pnrty,the reasonablc ntarket��11cie of Sueh itemS rnuSt be Ac�CIcQ (o thc ; <br /> eslimaled cost or contract price for pern,it fee Nmposes. In tI1Z CVC06 tIllLf II1G'C IS R CI15pllIB 031 II1L . <br /> amount oF the job cost, tl�e City„�fly rtq�tcsc tlie subtnission of a signed cop�•pf the�ciuni contract. � <br /> MEC,f-TANICAL C'�RMTT?�1��'LIC�ITION AG2EEMENT . <br /> The undaesigned hereby ap�lies to Uie City fvr issunnec of� �techanical Per���it, flgrees to do all � <br /> tYork ii� stE•ict �cca•dance with the orciiilnnees of tI�e City �nd t>>e regularions of tl�c Sk1te oF <br /> Nlinnesotn, anci etrtifes th�t all st�tements m�cle oi� this application �re eo�nplete. u•ue �nd <br /> correct. <br /> Applic�nPs Si�nature: �`� Date; � <br /> � <br /> i <br /> � <br /> 3 ; <br /> i <br /> I <br /> ; <br /> � <br />