Laserfiche WebLink
❑ Yes,this section applies <br /> The rpplaeemmt of a R 'a'12110 or app,0 that meets dl thM of the following requirements: <br /> l• >�ergnire modification to elocniea!ar gas seevice. <br /> I Has a tom of$500.W or less;"ging Ste cost of die fixture or appliance:and <br /> 3. Is improved,im"ed or neplaeed by the homeowner or licensed contactor. <br /> Skip nut sectioey if this applies; Cost of permit S 15.Q0 <br /> Stare Surcharge $ S. <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Totel permit Fee 5- <br /> If above does not apply;follow guidelines below; <br /> 1. CPPLMRA CE •is 1259�e%of conu*a price with a(Minb"U Fee of SM.00) <br /> `-' Od x.0125510D• 30 <br /> (conb.ctpace) (adulwuuo i'30.i69 <br /> 2. STATIE MM MGE CW0eY0 <br /> X.0005 >; <br /> (aonoacxyrioe) <br /> I POSTAGE&HANDLING(Oily on Mail-It,Applications) S <br /> 4. TOTAi,PE1tMT FSE(Add bines 1-3 Above) S <br /> • CONT A.CT PRICE or j0B COST means the actual or estimated dollar amount charged fur the <br /> permif6ed work inhaling materials labor,profit,anal other Sued coats. A 18 the ameuut to be charged <br /> to the Customer for the work done. If any material,equiptoenk labor at ins#allatiores are Mnished by <br /> the owvaar,tenant or eery other parry,the reasonable arlret value of such ite+ma umst be added to the <br /> estimated cost or coakaet price for permit lice purpom. In the event that theme is a dispute on the <br /> atnaunt of the job cost,the City may request the submission of a signed copy of the actual contreeet. <br /> The undersigned hereby applies to the City fox issuance of a Mechanical pwtnikto do all <br /> work in strict accordance with the ordinances of the City and the regulations of the State of <br /> Minnesota, ane certifts that all statements made on this application are complete, true and <br /> correct. <br /> Applicant's Signature 5 Daft. <br /> 3 <br /> £0/£0 39vd ONI -IVDINVH03W 00 6iZZb£b£9L t1Z:60 £Z0Z/90/90 <br />