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08-11—' 14 16:32 FROM— T-840 P0006/0007 F-932
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<br /> [] �es,this scction appl'res '
<br /> Thc re laczment of a�tesidential f kture or appliance that meets all thrcc of the following requircn�cnts: �
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<br /> � l. Does not require modification to cic�trical or gas service. �
<br /> 2. Has a total cowt of�500.00 or less;e�ccludin�ttie cost ofti�e fixturt or appliance:and �
<br /> 3. Is imr�roved,installcd or replaced by the homeowner or liccnsed cotltractor,
<br /> Skip next section,if this applies; Cost of'Pcrmit $ 15.00 �
<br /> Statc 5urchar�e S 5.00 �
<br /> Mail-Tn Pee(Tf Applicable) $ 2,00 ;
<br /> Total permit ree �
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<br /> ��rj�j ('�, y� /��p-,�.r�.,�cw _ n p (� n � �
<br /> 6� ��d%��4d�i0ri.� ���.�.�� �il� � � �l'�k7s/. $. "q. ,1.;(���,..5l, _a4...Q�,.
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<br /> Tf above does not apply;follow guidelines below:
<br /> 1. COIVT�.A[.:T pTiICE * is 1.25%of contracf�ricc with�(Miuimt►m�ee of$50.00)
<br /> � �- o�
<br /> X.oizs$�,,--
<br /> cpntract price) (minimum$50.04)
<br /> 2. STAT�S�{J�CHARGE �� �
<br /> x.OU05 � � -�
<br /> (Coltt�aCt pricc) !
<br /> 3. POSTACy�&�ANDLING(Only on Mail-In Applications) $ �fl� ��� f
<br /> r� � `
<br /> �Vi� �
<br /> 4. TOTAr,P�1tMCT�'EE(Add Lines 1-3 Above) $_, I
<br /> • � CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the �
<br /> perrnitt.ed work including m�terials,Cabor,profit,and othcr fixed costs. Yf is the amount to be eharged F
<br /> to the custozncr for the work done. If a��y mxterial, equipment,labor or insYallations�re fun�ished by S
<br /> the owner, tenant or any other party,the reasonable mar�et valuc of such items must Ue addcd to the �
<br /> estimatecl eost or contract price f'or permit fee �urposes. In the event that there is a disputc on Che
<br /> amount of the job cost,the Ciry ma�request the submissi�n of a signed copy of the actual eontraet.
<br /> 3;C..! l.�.l ,1: . .� "v , � � ''�f�l.V.A C�"CTY: `�`- Y�1rv.�\a',y� , "��t�
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<br /> �iG�;'i_•.��.. ^1°'Rt�G. '�� .a '��.�. �'� .,,. qX� `' �..��"An�1«w""�i. .r�5.
<br /> The undersigned hereby applies to the City for issu�nce of a MeChaniCal permrt, �grees to do a11
<br /> work in strict accordance with the ordinances of the C'rty and the regulations of the State of'
<br /> Minnesota, and cei�tifies that all staternents made on Yhis 2pplieation are complete, lrue and
<br /> con�ect.
<br /> C�-�/� �Date: � l � /� 1
<br /> Applicant's SignaturC: �
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