2015-00598 - gas line only - Laserfiche WebLink

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. � � � PE�'Yll 1 �£�6.rf1��'�.1�L�2 I�lr7�.3� � . .. � ..� � ,� �� BASED�UFP -�2002 S��TE�TATUE � ❑ Yes,this section applies The replacement of a Residential fixture or appliance that meets all three of the following reyuirements: 1. Does not require modification to electrical or gas service. 2. Has a total cost of$500.00 or less;excludina the cost of the fi�cture or appliance:and 3. Is improved,installed or replaced by the homeowner or licensed contractor. Skip next section,if this applies; Cost of Permit $ 15.00 State Surcharge $ 5.00 Mail-In Fee(If Applicable) $ 2.00 Total Permit Fee $ �, If above does not apply;follow guidelines below: 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00) I � x.0125$ J��.�� (c ntract price) (minimum 550.00) 2. STATE SURCHARGE � / � D� x.0005 $ � (O contract price) 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ �t�- �� ■ * CONTRACT PRICE or JOB COST means the actual or estimated dollaz amount charged for the permitted work including materials, labor,profit,and other fixed costs. It is the amount to be charged to the customer for the work done. If any material, equipment, labor or installations are furnished by the owner, tenant or any other party,the reasonable mazket value of such items must be added to the estimated cost or contract price for permit fee purposes. In the event that there is a dispute on the amount of the job cost,the City may request the submission of a signed copy of the actual contract. The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all work in strict accordance with the ordinances of the City and the regulations of the State of Minnesota, and certifies that all statements made on this application are complete, true and correct. � � J Applicant s Signature. Date: / � 3