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09/18/2015 FRI 12: 48 FAX 612 822 5408 Al' s Master Plumbimg U004/004 <br /> , <br /> , r ' <br /> R: n ni}c r t Ma i 'd" Ni�fH� <br /> �rt� , lis l t� a i t 1• V); <br /> ��`1 tl19• ' I� 1 1 ° +^•°,f sf � r } �� U !, IgJ! i V� 5i t !M t , . fici ql I, IPX 61i0� ,9�'.' Iwl� I( , t1i ' t l ��I'11'1 idi lil►'ii��!�� lei i t t(1I1'M it 1 t=Ar0 t o I l,g; �'�liE , i- I lI 'l1( tl l;� ,.d '� i i tO ! ����ia.1� 1. �� V f ( 4 1111! 1 <br /> ❑ Yes,this section • plies <br /> The replacement of a Residents. fixture or a..liancc that meets all three of the following requirements: <br /> 1. Does not require modi .'tion to electrical or gas service. <br /> I 2. Has a total cost of$500.0 I .r less;excluding the cost of the fixture or appliance:and <br /> 1 3. Is improved,installed or repla••d by the homeowner or licensed contractor. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> ate Surcharge $ 5.00 <br /> Ma n Fee(If Applicable) $ 2.00 <br /> 1�1 ' I " ' Total '. mit Fee $7 } I <br /> 11^94 4111114 KU +h r+�i Wit8ltNi l'?dflrilfi+f,a4!K9R�f;7f re III' '4f6h"r��ihMfMW��?1 E � T'V 014 ,i m°•'�i� �1P7}t'+If V i4 �1 i t i f SIJit"}M,`fljii <br /> If above does not apply;follow guidelines below: <br /> I. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> 9000x_0125$ 112.50 <br /> (contract price) (minimum 550.00) <br /> 2. STATE SURCHARGE 90004,50 <br /> x.0005 <br /> (contract price) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ .00 <br /> 1 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $1 \G\ <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 fee 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 /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all <br /> work in strict accordance with the ordies of the City and the regulations of the State of <br /> Minnesota, and certifies t t all( ateu+-t s made on this application arc complete, true and <br /> correct. I <br /> Applicant's Signature: l 1 1 bate <br /> g i Ic(()' . <br /> r . <br /> 3 <br />