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Oct. 5, 201� 3: 14PM No, 4�35 P, 3i3
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<br /> �i -i � .+ �G 17
<br /> ' ', li I i '. I� p� m�d I i �.ti�I i.. . . . � �i i 9.,���i°�i����i���,� �� �Y
<br /> ' ' � �S��4p� , ��02 ��'A;��T�'TC7E` r
<br /> . : , : . : � � �. �:,.r .�.� ��; . , ;��
<br /> ❑ Yes,this section app�ies
<br /> The replacement of a Ressdential fixture or aQpliance that meets all tluee of the foltowing requirements:
<br /> 1. Does not require modifieation to electrical or gas service.
<br /> 2. I-�as a total cost of��00.00 or less;excludin.Q the cost of the fixture or appIiance: and
<br /> 3. Is impro��ed,installed or replaced by the homeowner or licensed contractor_
<br /> Skip next section,if this applies; Cost of Permit $ 15.00
<br /> State SuCcharg� � 1.00
<br /> Mail-In Fec(If Applicable) $ Z.00
<br /> Tata�Permit�ee $
<br /> ,.�; �a ,. y P R7� l��� � e r � i � �S � i 9 r��,, I I G t
<br /> r'l'If��,��d!S a.�'f",�li{r�4.:.'fl�f4 t� � ��"� �.���'��''� � ,'��I.�i; '�� �' t , � ���V�.�. I�s,fl;ljn,t�1 �`� 3,h1,�Ij�,I �f ;
<br /> i,'i�..a a i ��.
<br /> If above does not apply;follow guidelines belaw:
<br /> 1. CONTR�iCT PRICE * is 1.25% f contract price with a(,'��wnimum Fee of$50.00)
<br /> �� x .0125� �jU - �O
<br /> (concrsct pnce) (minimum$50.00)
<br /> 2. STATE SURCHARGE � ' `,
<br /> x .0005 � �
<br /> (con[ract pricc}
<br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) � 2.00
<br /> 4. TOT_AI.PERMIT F��(Add Lines 1-3 Above) $ � .��
<br /> ■ * CONTRACT PRICE or JQB COST means the actual or esti�nated dollar amount charged for the
<br /> pennitted work including materials,labor,profit,and other fixed costs. It is the amount to be charged
<br /> to the customer for the work done. I�a��y material, equipment, labor or installations are fumished by
<br /> the o���nCr, tcnant or any other party, the rcasonablc markct valuc of such itcros muSt bt addGd to the
<br /> zstimated cost or contraet price for permit fee purposes. In the event that there is a dispute on the
<br /> amount of the job cost, the Ciry may request tlie submission of a signed copy of the actual contract.
<br /> 1 ��.�t � � � Ik�ifl�t N�I.'.�. ,,.,:rry Y '� ii_.� ,��,. � ' . ��6'� �� i� � .i�i.Cl
<br /> i ,`'ff:i�f���lti���^�tf,.11l�'� of;' i1 � d�. ! t v � �",t:' ,� � I,.( � � y�i �� ! i i���i. f�� �� i .r, �
<br /> � ' !Z'� t� ' . �.!�� !� ,s ,�:i:'
<br /> The undersigned hereby applies to the City for issuance of a Mechanical �ermit, agrees to do all
<br /> work in strict accordance witk� the ordinances o� the Czty azid tYze regulatiozas of the State of
<br /> '.vlinnesota, and certifies that all sta.tements made on this application are complete, tnle and
<br /> coiTect,
<br /> Applicant's Signature: bate: �� � �
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