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. �'�]�.�.��CAX.CYTLATYUM[31 <br /> 2i}0�St�,te.,,,�g,� ❑ kes T'hi�Setti�APptics <br /> The replaGatt�enc of a Residea�ial �xture or�Q.,liance�lzat rne�rs�I!trc�af the fallowing requircments: <br /> l) J�oes not requi,re maddflr,�tipra to etectricai or�as service. <br /> 2) H�s e,�„�,�of$54C.OQ or Eess;excludin�Q the oos-�c�f rha fixture or applir�nce: <br /> and <br /> 3� Is improve�, instalted or replaced!�y ihe homeawn��ar licer.sed contractor. <br /> Skip next seatian; �ost af F'ermit �-- 15.A0 <br /> State$urchargc$ ,SO <br /> Mail-Xn Fe�e $ <br /> If a'bova daos nat apply, follaw�uideiines beIow; <br /> l�. C�n ct rice*is.Qd?5%oFjob with a�natla 1_�ec oi f�35.00) <br /> J�C��-- x.4125 $ � <br /> (contrsct pricr} (minimum S3S.00) <br /> 2. 8tate 3urchar�e_**Add d�e gcat�Hpilt3ing Codc pivisio:t a�iaeemam Fee oF �� <br /> ��^ 2 <br /> — `��.(� ' x ,0445 � � � <br /> {con[rACl3rfiCe) tm;n�mum�.SC�j <br /> 3. Pustage aad Handlin� (Only a�nal�.in applicatinns� $ �.�0 <br /> 4. 'Tl'�'Y'AI,PICRMIT.�7EE(Add lines i-3 at�ove) � -,--.^TS/�< � ... <br /> "'CON1'ftACT pRICE or 30$f'OST meeats tt�e urtual or rstimatcd dollnr amaunt charged fqr itte perm�xted work including <br /> maierials,fabor,protit,and ashcr�xed sasts,lt is thc am�ur►[o be chair$ec!ta�he custqmer�'pr the work donc.kfarr;y mazertat: <br /> equipment,!«lwr.or��stallation is furnishcd by ct►c ovvt�er,u��ant or�y ah�r pQRy th,t rep,qanabJc.market value of such items <br /> rttust b�adOeQ to titc tstitt�atad cost or contt�ct pricc ios pe:^mrt t'ze}�urpoSe3,:n ehc rvenc that therc is a 4isp�.tt on the amount of <br /> t:1t yab sost�1ha Ciry enay request ehe subroiss:oq ot a si,grrG4.,c�py oT tht sCSa�i Cuntatc� <br /> *"The STATE SURCx�.ARG�.is•.�QOS oftheconira�t price un�e�$l;OOO,OOC or$.SQ.whichever!s gress��,FUT YG{URLi0tT9 OYCf <br /> �l,04t3,00G cali chr D�nranom af Inspectional Services for chc prEce. <br /> Thc undcrsi�racd hC�eby�pplies to the Cily Epr issualnCc pf a Mrchanicai Pt.rmit,s�tr.es to Jo�(l wark it1�trit�accardence w;th <br /> the orcfinances af t�c City and th:rrgulntiorrs ofth�Minnasa�a�sat�Huil�ing Cade,and eert�ties�hut at!ytatements ma�c an;his <br /> appl�c�;ion are carnptcte,trua end carncca. <br /> Applicant's Signature•_ ��`2���"}�-- <br /> ...,..,,,....� - aat�:� <br /> ��praved B�: ����' <br /> 3 <br />