2015 - 00786 - mechanical - Laserfiche WebLink

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....v.m.surp.inosai.kmemeatemisoneanmenitiewieourvoatimssoiasutinNINIZNIIIMI4VIIIINIIIIIIRRYSMINIllilliglialliiii...111*.1111111.1 . &,711.,i,12f119 i" :04 44.5,'2,-....:,i4;1; -.',I.1'`. 7,.: -JP'II^i-t PAGE 05/ri7 _ PERMIT}TEC• - ' I:101`4(S) i ElmEz opP.260i:STAIktrAITIE i ..,... — E Yes,this section applies The replacement of a gLesidgmialimAre_ouppliance that meets all three of the following requirements. I., Dots-not require modification to Clettical or gas service, 2. Was a total cost of$500 Co or less;eathding the cost of the fixture or appliance:and I. is unproved,installed or replaced by the hyrneowner or licensed contractor. Skip next section, if this applies; Cosi of Permit S ISA() State Surcharge $ , 5,OQ Mail-In Fe{(If Applicable) S 2.Q Tout Permit Fee S , 1 PERMIT FEE CALCULATIO ' -JOB$°VIM i 1;00• If above does not apply; follow guiticlines below, I. CONTRACT pfkIcE * is I 2 %of contract price with a(Minimum Fee of SS0.00) 2,50 0.0 C) x 0125$ 12 56,60 icontracl pr,ce) (rliirtimbei S50.00) 2 512iTE,11,a4gliliZE. S t ,26 ttosiratsci poet 3 POSTAGE&liANT)LING(Only on Mail-In Applications) S_ La2. 0 4. TOTAL PERMIT FEE(Add Lints 1-3 Above) S .57. 2$ • . 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 are finished b) the owner, tenant or any other party the reasonable market value of such hums must be added to the estimated cost or contract price for permit 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, ,,N112OHA/41CAL Pflaitir . -LICATIdN t• t..ilr 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, d.....42*. Applicant's Signature: : 4 ' 9/ -4r Date, — /„6...._1 , ,.. . A