2012-00921 - gas line only - Laserfiche WebLink

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f PER1�T FEE�AL�LI�.A.'I'�U1��} BASED O�'F'-ZUQ2�TA'I'�ST�T'� ❑ Yes,this section applies The replacement of a Residential fixture or appliance that meets all thtee of the following requirements: 1. Dces not require modification to electrical or gas service. 2. Has a total cost of$500.00 or less;excludine the cost of the fixture or appliance:and 3. Is improved,installed or replaced by the homeowner or licensed contractor. Skip ne�ct section,if this applies; Cost of Permit $ 15.00 State Surchazge $ 5.00 Mail-In Fee(If Applicable) $ 2.00 Total Permit Fee $ FERIVII'T`FEE��:L,�CUE:.A."i'If}� 5' -�Jt3��C�VER$5�.4�} : If above dces not apply;follow guidelines below: 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee ot$50.00) / 00 � •�(O� X.�i25$ (contract price) (miaimum 550.00) 2. STATE SURCHARGE x.0005 $ (contract price) 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) S • * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged 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 aze furnished by the owner,tenant or any other party,the reasonable market value of such items must be added to the estimated cost or contract price for peimit 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. ; 1�ECH�NI�AL`P�R'�T'�'PT.ICA�T4N;At'sR�EFME1�3'I' The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all 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 are complete, true and correct. ApplicanYs Signature: �— Date: / :f�nt 3