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10/21/2016 FRI 14: 39 FAX 612 822 5408 Al' s Master Plumbimg 12004/004 <br /> '` iC... ds, r A' twi tl lq dl . Gr 11� tl l q ? r 4,1 <br /> �'R r i t 1'1 ri1(11 ',tr{fir a 1 IL"' a'E` rl., fjtl� .w '� 4.�," ��r t, r 1 1 <br /> l i <br /> 1i�.11tiPv111, � �J r ! �N1 •'lfi+*Vm 2 ,. � 'IF� h ;'�:.Vi1 Fr .Att;iY, r1, { '�{ I � � <br /> Yes,this section applies <br /> The replacement of a jjdential fixture or: ian : at meets all three of the following requirements: <br /> 1. Does not require modi ation to electrical or g: 'ervicc. <br /> 2. Has a total cost of 00.00 or less;excluding the co the fixture or appliance:and <br /> 3. Is improved,i ailed or replaced by the homeowner or r :r sed contractor. <br /> it <br /> 1 Skip t section,if this applies; Cost of Permit $ 15.00 <br /> State Surcharge 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Pee <br /> J 9„p 11,33•: iPru: stLLI ' EnTI 8 0•,1 r i r ^ nTnt11 <br /> If above does not apply;follow guidelines below: <br /> I. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Tec of$50.00) <br /> Lo r70 x.0]25$ �a <br /> (contract price) (minimum 550.00) <br /> 2. STATE SURCHARGE rl U 0 p <br /> x.0005 $ <br /> (contract price) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ 0, - 154? <br /> • "` CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the <br /> permitted work including materials,labor,profit,and other fixed costs. It is the amount to be charged <br /> to the customer for the work done. If any material,equipment, labor or installations are furnished by <br /> the owner, tenant or any other party,the reasonable market value of such items must be added to the <br /> estimated cost or contract price for permit fcc purposes. In the event that there is a dispute on the <br /> amount of the job cost,the City may request the submission of a signed copy of the actual contract. <br /> F <br /> i 1 I i ) 4'. 'r .1�( •,lllri "'C f M 1 , R lir 11.`�� rwi tl�' t�S�N N�.'1 i�i � r�,r r �4.�.nl>�r"n p�..r�"r'"�rFY1, <br /> ,.,a,r.:.,,.11�a,•,�r 0 , .1 s.,., „al, I'� lti�-. 1Gr i �« r9!1+ 111.1 t 1, i 1.,:i, �� <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all <br /> work in strict accordance with the ordinances of the City and the regulations of the State of <br /> Minnesota, and certifies that all statements made on this application are complete, true and <br /> correct. /� <br /> Applicant's Signature: Aly �i// Date: t C ( 'd 4 1 (`U <br /> 3 <br />