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10-27—'17 07:28 FROM— T-048 POQ03/0004 F-429 <br /> �s� � '��''�+, ' '��i, �' :t;�. ;<< - �,..._ t � � � ^ <br /> ;t �..-� ?:``S,`,� '.J.:`' s l, � ; <br /> �. <br /> ❑ 'Yes,this section ap�lies <br /> 1. Does not requirc modification to electrical or gas servica. <br /> 2. Hss A toCal cost of$500.00 or 1ess;e1�cIudir��the cost of the fixture or appli�ncc_And <br /> 3. Is impro�ed,instal'led or'replaced by the homeo�mer or licensed contraetor. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Suscharge � 5.00 <br /> Mail-In�'ee(Tf Applicable) $ 2.00 <br /> TotAl Permit�'ee S <br /> :�'' y�''.�"��;����f....��'�-'.:`�''�.��.�.� '�.�'.��^ ,.��.�.. .... �,.TM <br /> Ifab�ve does not apply;follow guidcIines below: <br /> 1. CONTIiACY'PYtYC� *is 1�S%of contract price with a(119inimum Fee of$50.00) <br /> �U�� x.0225$ �� p� <br /> (COMrBCt ptiC6) (minimµm S30_00) <br /> 2. STATE S�RC�YA�tCr� �J/i z���' �.0005 $ ��S <br /> (� ./ <br /> (Conuact price) <br /> 3. P�STAGE&HANDLINCr(Only on Mail-Tn Applicntions) $ 2_00 <br /> 4. TOTAL PERNIIT�'��(Add�,inr,s 1-3 A.bove) � � ��� <br /> ■ " CONTRACT pRCCE ot 70B COSx means the actual or astimattd dollar amounC chtuged for the <br /> ptrmitted work including matarials,labor,profit,and other fixed costs. It is the amount to be charged <br /> to the custom�r for the work done. If any mat�•i&l,equipment,labor or installations are furnished by <br /> the otvner,tenant or any othtr parCy,the reasonable market valuz of such items must be added to tht <br /> estimated cost or contract piiee for permit fee purposes. In the event that there is a d'upute on the <br /> amo�mt of the job cost,tht CiCy may rC9uest Ihe submissloln of a Signed cqpy pf the actval contrset_ <br /> .�. ,. <br /> �. . .. o <br /> .1W:'.,�. �,n•ti y5��we, ,1, a ��ryd t.�.1:: �n L•. <br /> ;;t,..}:,�:�t;::�,;���4�'�cr� .4�:�A�l���i;��'..�s��;�rx�`�',A:.�I'����::�I!��Q�..::c�:,��-���$���'�' �� ����:�: <br /> The undersigned hereby applies to the City for issuance of a Mechanical permit,agre�.s to do all <br /> work in strict accordance with tho 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 /> correct. <br /> Applicant's Signature: .� �� Date: /(J � <br /> 3 <br />