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07-01—' 15 16:34 FROM— T-442 P0003/0004 F-244
<br /> �In) .� /1 �� 4 � r� N 7 „ � �� r � � � d�ti lrf�. w �•F d ���:. J
<br /> ��v�� �z`s'�`E�,a; � n,�° ,, �., ;P�` �`y�Fk�C��'I.,CU.� A�TIQI�1���)'� ,$ �� �, �� �,�, ,;ati;
<br /> ��t�i��� 6i , e�e yr���Y i i �� �gU �S 2�A ���'y ,��� r .c,.i t lr � i .1' n � i�� r� �! r�y�i
<br /> �• r �] �;�7 (y(� �'77^ �7C1'7'/� y}�, .�,�� V �,r. JI 5.
<br /> �y`�„�„��c,��r,�<�'.1 r.��'.t4..rmr e�:�n,�.7Rf `!a,>���.!i�:��,A�F'..£.:�V.V�.r4J.'1.(R�L'i.'*'-1 A f�1,��1+'. .�.4.f r�id.h�lr����s�h'�+n����1�
<br /> ❑ Yes,this secti�,�applies
<br /> The replactment of a Residential f'rxture or appliance that meets a1€three of the following requirements:
<br /> 1. TJo�S_,»�t require modification to electrical or gas scrviee.
<br /> 2. �Cas a total cost of$500.00 or less;exeludin�the eosC of the fixture or appliance: and
<br /> 3. 1s improved,installed or replaeed by the homeowner or lieensed contractor.
<br /> Skip neact section,if this applics; Cost of Permit $ 15.00
<br /> Stata Surcharge $ 5.00
<br /> Maii-Cn�'ee(rf Applicable) $ 2.00
<br /> Total Permit Fee �
<br /> � �� _
<br /> ��i�.1?l�%+$���4.�i.�:�,C��ir�1�l„����.4:;L'�-l�4-!�Li���1i��1`((�1) ��1,�D��jY��.J�i[7i�S,VVPU�� Y:,c 3���,,�G.f 5���' �
<br /> If above does not Apply;folfo�v guidelines below:
<br /> 1. CONT�tACT PRrC� � is 1.25%of cUntr�ct price�viCh a(Minimum Fcc of�SOAO) �
<br /> 9,345.00 `z".9125��; 11G;�£r,1 � ::: , ;``!
<br /> , ;
<br /> �(�l2c)q'i�t Pdit$).- '(�11�i1ilm�►N[i.�SO��)`
<br /> 2. STATE SURCHARGE 4.67
<br /> 9,345.00 x;;U005,':'��z
<br /> �(Coniraet,p'rrc;�j,
<br /> 3, POSTAG�&HANDLiNG{Only on Nlail-Cn A�plications) $'u�.�,,„����
<br /> 4. TOTAL PERMIT FE�(Add Lines 1-3 Above) ,$_', 1Z.7�'4� �`. '
<br /> ■ '" CQ1J'C'�ZACT PItCC� or J0� COST means thc actual or estimatcd dollar �mount chargcd for the
<br /> ��ermitted work including materials,labor, profit,and othtr fixcd costs. It is the amount to be charged '
<br /> to thc cti�stomer for the work done. If an� material,equipment, labor or instAllations are furnished by
<br /> the owner, tenant or any other parry,the reasonabte market value of such items must be added ro the
<br /> estimated eost or eontract price for permit fee piirposes. In the event that there is a dispute on the
<br /> amount of the}ob cost, the City may requcst thc submission of a signed copy of the�ctual contract.
<br /> 1
<br /> I!'�, i4��;r:',v r 4` f���.ri`r . . ., ... . .., .---��---- � .:
<br /> �,,r.�.,:.,� , ..�.r t � �'���X�'�°'�'';�',-�;,M,.'�I'�,APp�.�GAT��N,!�,�.��It!I4I�"�',�^,.:2,,,; �,�;r�'`r�;.
<br /> �
<br /> The ucidersigned hereby applies to the City for issuahce of a Mechanical Permit,agrees to do all j
<br /> work in strict �ccordance with the ordin�nces of the City and the regulations of the State of j
<br /> Minnesota, and certifies that all statemenSs made on chis application are corr�plete, 1rUC Snd �
<br /> con•ect.
<br /> i
<br /> ApplicanC's Signature: �� �--�V�f''GY� t�at�;:;; 7/1/15
<br /> 3 �
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