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11-30—'16 15:11 FROM— T-480 P0006/0016 F-583
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<br /> ❑ Yes,this section applics
<br /> The replsCemen[of 8 Residentisl fixture or appliance that meeis all three of the following rcquirements;
<br /> 1. boes not require modi�cation to electrical pr gas service.
<br /> Z. �Tas a total cost of$500.00 or less;cxcludine the cost of the�xture or appliance:and
<br /> 3. Ts improved,installed or replaccd by thc homeowner or licensed contractor.
<br /> Skip next section,if this applies; Cost of Permit $ I5.00
<br /> 5tatt Surcharge $ . 5.00
<br /> Mail-In Fce(If App)icable) $ 2.00
<br /> Tot�l Permit�ee $
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<br /> C� �:�-}y�y.� jy +� p;�TA,� n*T �y �cn �_
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<br /> ��s��wi.~:�t',���...����,�=;�x�'.,�� ,i��L�.Lx,t�:+,f.? �`,.z'S%��?'��l�:�J.'!.`�-�^-.4� ,.h�'„'�`_�, � �� ��!�Q=._.��..:��'- '„�r,ll�`�.,�.'��
<br /> If above does not apply;follaw guidelines belaw:
<br /> 1. COIVTRACT PRICE * is 1.25%of contract price with a(Iviinimum�ee of�50.00)
<br /> �� �'�� x.0125$ ���
<br /> (cantract prico} (minimuro 550.00)
<br /> 2. STAT�S�IRCHA�tGE �(� M'7 ry� � �
<br /> / G~� x.0005 $ �
<br /> (Cantract prico)
<br /> 3. POSTACrE&HANDLING{Only on Mail-In Applicat'rons) $ Z.00
<br /> �� ��, ��
<br /> 4. TOTAY.PERIVTTT FEE(Add Linas 1-3 Above) $
<br /> � * CONTRAC7' pItTC� or JO� COST means the actual or estimated dollar amount charged for the
<br /> permitted work including materials,labor,profit, and other f�xtd costs, It is tha amount to be charged
<br /> to the customer for she work done. Tf any material,equipment, labor or installations are f�►m;shcd by
<br /> the owner,tenant or any other party,the reasonable market value of such ittms must be added to the
<br /> esiimated cost or contract priee for permrt fee purposes. Tn the event that thcre is a dispute on thc
<br /> amount of the job cost,the Ciry may request the submission of a signed copy of the actual contract.
<br /> � '��[+/�1
<br /> r';*��`f?'�:f S}�,���,e....dY�A-!,�����,N �'r'�( •i�� $ � (;� �y ;f. �}�`�'x, :�r,ah„'4?. .�1�f,f��� N�
<br /> �. �Z�,:iRS U�' � �.�� '�� ...,l�ii3lfN/"+,'X .ta. �1.f��G,�:�h��i
<br /> The urtdersigned hereby applies Co the Ciry for issuance of a Mechanical Permit, agrees to do all
<br /> work in strict aceordance with the ordinances of the City and the regulatians pf the $tate af
<br /> Minnesota, and eertrfies that alt statements made on this �pplication are complete, true and
<br /> correct.
<br /> ApplicanC's Signatur� � �� _ l7ate; S�
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