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Oci-1l-2002 DA:19as Fro�-CITY OF OROMO +952Zt94616 T-24A P-004/00� F-602 <br /> •p� E S <br /> 200Z State Stxtate ,e Yes�Secaon App�ies <br /> The replacemmt of a Residential f{xnue ar ap�liance that mects all three of the following raquir�nents: <br /> 1) not require modificatiam to electrical�gas sdrvice• <br /> 2) Has a tot�1 cast of 5500.00�less;exc udin the cast of the fixcure or appliance: <br /> and <br /> 3) Is improved,imtalled or replaced by the homeawner or licenstd contractor. <br /> Skip next section; Co:�of Permic $ 15.00 <br /> Srete Surch�rge$ .50 <br /> Mail-fn Fee $,.,,,, 1.50 <br /> If above does not apply,follow guidelines below: <br /> l. Contract Price*is.U125%of job with a hlinimum Fcc of(�35 801 <br /> x.0125 S <br /> (connact price) � (minimum 535.00) <br /> 2.Ststte Surcb�e_.''*Add the State Building Code Division a Minimum Fee of(S.SOI <br /> x_0005 $ <br /> (conua�c�xice) (minimum�.50) <br /> 3.Pastaee and�idl�(OxlY arail-in apptica�io� R 1.50 <br /> 4.TOTAY.PERMI?FEE(Add lines 1-3 above) $ <br /> •CpNI'RAC1'pRIC£ar]U8 COST tneans s6c acwal or e�ima�od datur a�o+mt chcu$ed for dte Petmitted work mcluding <br /> m�aials,l�'�W'�•aid o[Ae�Sxed e�sts.h is thc s�wm[w be ctre��d to the eustoaw for the work doaa.If any�tuiat, <br /> pqu;pma�laba.a iastalimon is fineished by the awner�unau or any od►et party dic t�a61e markct valuZ of svch imns <br /> �p��d�p�=u��d c�a connaGc prae�r pemic fte pu�po�,.In the evmt that tlfer�e is a disputt on the amount ot <br /> du.job e�,+Lt C'siY m�'�eq�s�tbe submizsion of e sigaed copy af the xnnt oonuact. <br /> ••Thc STA'tE SURCI�IARGE is.0005 of tht cantract price under 51,0�,000 or S.SO-whichever is grmter.For vsluations over <br /> 51.000,000 eatl t6e Deparoacat of in�,xtional Services fa d�pria�. <br /> 'IUe m�detsigned hacby apptia to the City for is�of a Meehaaical Ponait,�S to do aU worlc in svict aecofdancc witll <br /> the ordinaaoes of tl+e City 8td the�gd�ony of the Minocwa S�xe Hnilding Code,mid«rtifies d+at a1l stiatemtnts made on d►is <br /> ���� <br /> Applicent's Signature: Dace:�a ''�'Q'�2 <br /> Approvod By. Date: <br /> 3 <br />