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� 08-26—'16 12:17 FROM— T-030 P0003/0004 F-037
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<br /> ❑ 'Yes,this section applies
<br /> The replacement of a Residentiat fixture or ap�liance that meets ait three of the follor�ving requirements:
<br /> 1. D e n require modification to electrical or gas serviez.
<br /> 2. Has a total cost of$SOU.40 or less;excludine the cost of the fixture or appliance:and
<br /> 3. Is improved,installul or replaced by the homeowner or licensed contractor.
<br /> Skip next section,if this applies; Cost of Pcrnut $ 15.00
<br /> State Surcharge $ 5.00
<br /> Mail-Yn Fee(�f Applicablc) $ 2.00
<br /> Total pern�it Fee $
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<br /> Tf above does nat apply;foilow guidelines below:
<br /> t. CONTRACT pRiCE '�is 1.25%of contrAct pricc with a(Minimum Fec of$50.00)
<br /> ��(� �� n o'O
<br /> ( � x.0125$ ��(./.
<br /> (conlcact price) (min�mam S50.00)
<br /> 2. STA'I'ES�'1tCHA1tG� ���V. �� `-""
<br /> x.0005 $�_ _______
<br /> (con�acc pria:)
<br /> 3. POSTAGE&HANDLING(Only on Mail-In Applicatipns) $
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<br /> 4. TOT'AY�p�RMYT�EL(Add Lines 1-3 Abo'vc) $
<br /> ■ � CONTRACT PRICE or 70B COST means the aenial or estimated dottar amount charged for the
<br /> parmitted work including materials,labor,profit,and other fixed costs. It is the amount to be charged
<br /> to the customer for tha work done. If any materi$l,equipment,labor or inst�INations are furnished by
<br /> the o'�vner,tenant or any other party,the reasonable market value of such items must be added to the
<br /> estimttted cost or contr�cC prict far pormit fce purposes. In the event that there is a dispute on the
<br /> amounC of tht job eo3t,the City may requcst the submission of a signed copy of the actua!contract.
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<br /> The undersigned her•eby applies to the City for issuance of a�echanical T'ermil,agrees to do all
<br /> �,vor�C in strict accordance �,vich the ordinances of the City and the regulations of the State of
<br /> Minnesota, and certifies that all statements rnade on this application are complete, true arid
<br /> correct.
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<br /> Applicant s Signature: Date: U �� f�O
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