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FEB-15-2011 07:52 FROM: T0:9522494616 P.3 <br /> ✓ ' <br /> F <br /> FFRMiT FFF.C'Ai.('l.II�ATJ()N(S) <br /> �3A5E1)UFh -2002 STAT�:4'I'ATUF� <br /> ❑ 'Yes,this sectiun spplics <br /> The�plscemcnl of s R.�i�rnti��fx�g q�nen��pe thut meeta all threc of thc fallowing rcquir�ments: <br /> l. Does nut require modificstion t�eleetrical ar gas service. <br /> 2. Ha!t a�,tal cnwt nf$SOl1_OQ or less;�x 3u ina the coFt of the�xture or appliance:and <br /> 3. l�improved,installed or rerlaced by the hpmeowner or IicGnxed cunhraetor. <br /> Skip next section,ifthis applies; Cast of Perrrtit $ 15..4� <br /> State Surcharge $ 5.00 <br /> Mail-in Fcc(IfAppiicabla) $ 2.OU <br /> Total permit Fee S,.,_„�, <br /> PFRMTT FFF CA1,C:ULATi()N S —JC)�iS()V�R�50n.U0 <br /> Tf Above does nut apply;fullow guidclines below: <br /> I. CONTR�ICT PRICF, •ix I.25%of cxmtract price with a(Minimum Fee of SS0.0(1� <br /> x.0125$ � ' <br /> a�nRact�rico) (nilnlmum SSOAD) <br /> 2. STA,�+'�,URCAARC� Q(� <br /> x.UOUS $ � - <br /> (conauct prico) <br /> 3. POSTAG�8c I-iANDLiNG(Only on Mail-1n A,pplications) � . .. _..2,04 <br /> 4. TQ'I'Al.PFRMIT FEE(Add Liucs 1-3 Abovc) S ��� <br /> ■ w CONTIZACI" pRIGE ar JOB GOST means the Actual or estimpted dqllpr wnount churged li�r tht <br /> permittted work including ma#erinis,labor,proftt,and othzr fix�i co�tc. It i8 thC umuunC tn bc ehurged <br /> ta the cuatomcr far nc�work done. if any rrtaterial,cquipment, labor or insGiltations,uo fumishod by <br /> dtit�wncr, tenant or any other pwty, the rtasons�blo m�rkot valuc of�uCh itarru� muaC be addod to thc <br /> �tunated cost or convact price for pertnil !cc purposes. ln thc cvent that thcrc is a dispute on thc <br /> amount of the jab cort, thc City may request the �ubmission of n aigned copy of the uctiu�l contract. <br /> MCCHAN1CA.la.!'ERMTT APPI,IGATInN AGRFi:MF,N'T <br /> 7'he undersigned hereby applies to the City for issuasace of a Mechanical Permit, agrees to do all <br /> work in strict accordancz with ehC ordinanc�s of the City and the regutntions of the State of <br /> Minnesota, and cortihes thut all statementa mAde on this applic�stion urc cornpletc, true and <br /> correct. <br /> Applicant's Signaturc: bate: ?j� 5 J,S <br /> 3 <br />