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F'E�2.�9T FF.E CA�.CLTI..�TIONiS) � <br /> "_'OOZ State Statute [] Yes Tbis SEcticrn ,��clies <br /> Tlie replacement of n Residential fi.tur�or a�;,tiance�ha:meers all threc��f the following requirements. <br /> 1) i3cKs not r.quse mad�ficaiion to e;.cvi�al or gas servicc <br /> 2) I-I�a totnl cost pf�509.00 or less; exclucii�the cast of the fi�turc or appliance: <br /> and <br /> 3) Is improved, ins'talled or replaced!��:the homao�vner or l�censad contractor. <br /> S?cip next secrion; Gc;st c�f Prrmit $ 15.0O <br /> S�ure Snrcha oe $ 50 <br /> ��ail-Tn Fe� � 1.50 <br /> li abuve �lues not appty, follow•guidelinati bcl�w: <br /> t. Contract Price" is .O l25% of job�.vicr,a bTin�mnm Fee o[(S3S•OQl <br /> c�C.�'C`��, �'Z- x .0:Z S � :.,�J�•C�—% <br /> +�connact prce) (miriirnum S35.Q0) <br /> ' State Surcharee. *" Add the 5tate F3uilding C_`n�le I'�i�•ision a Minimum �ee oY(S .SO) <br /> :�( , ��; �'�:;,..000s � / :3C�. <br /> l=ontr�.ct pncc} �,mir.,mum b .SGj <br /> � Posta�e and Handtin�(Onl��rarai!-in upplicati��ns) � _ 1 5� <br /> �7 � <br /> � TOTAL PERI�IIT FLE(Add lines ?-3 :�h,.�c) $ / � � <br /> � !'OKTR�CT PRICE or JOB CUST mcans:}c actaul ur escr.atc i dollu amuunt ct�arYed for�he penr;i�tc3 wori:incf.:dln� <br /> n.3!erisls,labor,prof.t.an�other fi::ed�o�Ts'.I�'.�t;+�amc�.nt co��c char�d to the cu9tomer for tha�vorV;donc, If any n•,areria;, <br /> •.�uipmcnt,Ishor,or inst.nllation u furnishrci by thc own::,tor,aic or any o�hcr parry[he r�oaab;z msu'ktt�aluc of svch itcr�s <br /> tnwt ba 2dde1 to nc�cs:;rr.sted cost or contran Frice fb�p�rn:,t.'ee purposes (n the even[that thert is a dispu;e on�t�e a;Y.ount o+.' <br /> tn�,��r eoit,�he City may requcst thc submission of a s�tl�ird.�p;of tRe 3etu�l wnttu:. <br /> '•Ti�c STATE SURCHARGE is.OQ05 of t�e contrsct pr:cc Gncer S1,000,0u0 ur S.3U-whichcvcr is grra�er. For �ul�:a:on�o�er <br /> S'.,OOC,���cull the Depzrcmv�c ot 1n��ectWnal 5err�ce:for tf.c priec. <br /> Tha u�drr�ignec hertby a�pi�as co che Ciry far issuaneK oP a;�'.e.hMicai Per.r.it,agr::s to do a:!�.vor1:in strict acco;daoce Nith <br /> �hr orCinanc�s of s�:Ciry::nc che rtguluions of the Minnrsoia Sc�tc Buildlrg Code,and ce�*Ifles that al. S[t�[ements msdc or this <br /> application azc complcto,�nic and conr � <br /> ��- j�� ;' <br /> \�/J -'" ��.'.a''��1 �.-� <br /> �pplicant's Signature: ----- --------. _.------------ Date: — <br /> ��proved By: Dat�: <br /> 3 <br />