2012-01022 - gas line only - Laserfiche WebLink

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�. PERIV�T FE��.��'1��T�) Ei3�`..��5�'�'F�5'.��.3`�:; _ ❑ Yes,this section applies T'he replacement of a Residential fiacture or appliance that meets all three of the following requirements: 1. Does not require modification to electrical or gas service. 2. Has a total cost of$500.00 or less;excludina the cost of the fixhue or appliance:and 3. Is improved,installed or replaced by the hom�wner or licensed contractor. Skip next section,if this applies; Cost of Permit $ 15.00 State Surchazge $ 5.00 Mail-In Fee(If Applicable) S 2.00 Total Permit Fee $ ... .:��... ��V�i�� `� `i""��a��4� �- .. � If above does not apply;follow guidelines below: 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00) i I�� X.oi2s s (contract price) (minimam 550.00) 2. STATE SURCHARGE x.0005 $ (contract price) 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PERNIIT FEE(Add Lines 1-3 Above) S ■ * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount chazged for the permitted work including materials,labor,profit,and other fixed costs. It is the amount to be charged to the customer for the work done. If any material,equipment, labor or installations are furnished by the owner,tenant or any other party,the reasonable market value of such items must be added to the estimated cost or conttact price for permit fee purposes. In the event that there is a dispute on the amount of the job cost, the City may request the submission of a signed copy of the actual contract. ' �HA1��t��'�t�+1iT AP��,�+��'��AGR��i��' ' The undersigned hereby applies to the City for issuance of a Mechanical Pennit, agrees to do a11 work in strict accordance with the ordinances of the City and the regulations of the State of Minnesota, and certifies that all statements made on this application aze complete, true and correct. Applicant's Signature: Date: �U I � �� '�� 3