2016-01162 - gas fireplace - Laserfiche WebLink

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09-22-'16 08:24 FROM- T-110 P0003/0044 F-127 ' � 5 i ❑ Yes,this section applies The repiacement of a�'esidential fixture or applianr,�z,,that meets all three of the follovving requirements: 1. boes not require modification to electrical or gas serviec. 2_ Has a t�tal cost of$500.00 or less;�xc}udine the cost of the fixture or apptiarice:and 3. Ts lmpro'ved,insta11ec1 or repiaced by the homeowner or licensed eontractar. Skip next section,if tlzis applios; Cost of�ermit $ 15.00 State Surcharge $ 5.00 Mail-In Fee(If Appficable) $ 2.00 Total Per�nit�'ee $ If above does not apply;follow guidelines bzlow: 1. CON'T12ACT P�2XC� �is 1.25%of contract pricz with a(Minimum Fee oY$$0.00) �o �b �• x.0125$ •�•. (contract ptite) (mfu mum 530.00) 2. STA'X'�SYIRCFYARCr� � I��o� X.00�s $ C�. 1 � (contracc price) � � 1� 3_ POSTACr$8�HA1�Y,TNG(Only on Mail-In Applications) $ � �0 �� 4. TOTAX.pERMIT��(Add Lines Z-3 Above) g ` � 4 CONTR.ACT��tTC� or JOB COST mcans the actual or eatimated dollar amount charged for the parmitted work including materials,labor,profit,and other�xed costs. It is the amo�mt to be chargcd to the customer for the►�vork dona. Tf tsny matcrial,equipment, labor or instaqations are flunished by the owner,tenant or any other party,the r�asonable market value of such iCems must be addcd ta the estimated cost or contract price for permit fee purposes. ln the evetlt thAt there is a dispute on the amount of thz job cost, the City may request the submission of a si�ned copy of the aCtual contract. ; The undersigned hereby applies to the City for issuance of a Meckianicai Permit, agrees to do all work in strict accordance with the o�dinances of the City and the regtilations of the State of Minnesota, end certifies thaC all statements made an this application are complete, true and correct. Applicant's Signature: r �� bate: �� J 3