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07/14/2'009 13:52 FAX 95275876�2 STASNEY �iECH f�j001/001 <br /> , � <br /> ❑ Yes,this section applies . <br /> The replacement of s$t����g��-�ar anolianse that mcets all tlua of the followir►g reguirements: <br /> _ 1, not require modification m electrical or gas service. <br /> 2. Has a�of SS00.00 or less;,�y�,�the oost of the fixture or sppliance:and <br /> 3, Is improved,installed or replaced by ihe homeowner or licxnsed contractor. , <br /> Sldp next secxion,if ffiis applies; Cost of Ptrmit - S IS•00 <br /> State Surcharge S�Q <br /> Mail-In Fce(If Applicabte) S Z.OQ <br /> Total Pcrmit Fce s <br /> If above does not apPly:follow guidelines below: <br /> 1. �OIVTRACT P�CE.*is 1.25%of contr�act price with a(Minimam Fee ot 550.00) <br /> � G � x.Ol25S � ���► �� <br /> ( oonact prioe) (mini�rwm Sso.00) <br /> 2, CTA7'F.Si�RCHARGE **Add the Stste Bidg Code Div.Sutcharge(MiOim�ua Fa of S.SO) � <br /> �'U � , L�C�� x.000s S��._. .�.� <br /> ������a� (minimum S .SO) <br /> 3. POSTAGE&HANDLING(Only on Mail-ln Applicationa) S 2.� <br /> � / 3�0 � <br /> 4. TOTAl.PERMIT FEE(Add Lines 1-3 Above) s • - i <br /> • * �pNTRpC'I' pRICE or JOB CO3T meaoa the actual or estimated doUar amount char$ed for the <br /> peranit�d w�ork inchiding materi�ls,lsbor,pco6t,�nd otha fixod oosts. It is the amo�mt to be cherged <br /> to ifie customer for the work done. If any metaial,equiprnex�t,labor or inatalletions e�e fiunished by <br /> the owner,tenant or.any other psrty,t6e rasonable market value of such itans�mn�t be sdded te ffie <br /> q�ed oost or 000traet ptioa�Pa�nit 6ee pwposa. ln the eva�t tfu►t thete is a dispuu on ffie <br /> �of Ibe job cost.d�e Cib+ �Y�N�the sobmission of a signed copy of the actual contrect. <br /> � • R�Tbe STATE SURCHARGE is.0005 of the Building Departrnent at(9S2)249�600 f�d�e pria. <br /> . , <br /> The undersigned hereby applies to the Ciry for issuance of a Mcch:u�ical Permit.agrees to do all <br /> ,n,ork in strict accordance with the ordinences of the City and the regulations of the Stata of <br /> Minnesota, and certifies that all statemeirts made on this applic�tion are complete, true end <br /> cocrect. <br /> Applic�nt's Si D�:����� <br /> _. _ -- 3 <br />