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04127/2015 1 5:11 GLOWING HEARTH&HOME (fAX)952 492 6006 P.002/002 <br /> It i <br /> iiG2. i k. ! x1.0: <br /> ` 5 1 I^N• 0r"�4 r�v' <br /> ?�' w kR � ��: 0•,,5;4:1;:44,4-1 <br /> � "44,4-n � <br /> q c••, rt�J��� �amAY�(� � �10 �; .° 010"0,,,% 11N ! 4ANV <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture oy appliance that meets all three of the following requirements: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excluding the cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or Iicensed contractor. <br /> Skip next section,if this applies; Cost of Permit $ <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> _i.;iir'— f •.� P .........�.. !r114/14';'.'", <br /> 'i.^ r{�dd!yauti.__�.r, a te,..WAV 1�V1r.Jr ,.' '7.i .�i,�l,i"• �LdMrewa4 '0"),! <br /> u tit°wre, °gym°�ti1U l 1u�w Ge ��.{d( <br /> If above does not apply;follow guidelines below; <br /> 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum F e Qf$50.00 <br /> 1 ki x.0125$ Cl <br /> (contract price) (minimum$50.00) <br /> 2. STATE SURCHARGE "1( 6 6Z) q).VV cc�� x.0005 $ <br /> (contract price) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ 11- <br /> • CONTRACT PRICE or 108 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 /> T •- ,rci r,R v � `;�{ IV,s;.,�;1�1 Y"�l ;c:� 1q�^ , ., " „'"Yrti..` ' � � ,i� '�Z ,� . <br /> *Eft'�il� 1J P E1 ;�• �. .t <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 /> CI! ' +9\1-'1 <br /> Applicant's Signatur 1 Date <br /> 4 <br /> 3 <br />