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, 02-10-' 16 15:42 FROM- T-649 P0003/0004 F-033 <br /> f <br /> t <br /> � <br /> h ., >,k.iy4 ���k�.t'��'��LAL�G3�.�.���?I�f(�� ;� ' SK-„� t�w�y y�; EF{ <br /> u _',<: � ..�r K��,'.. -� { r�; ._ .,,� � 1� �3y 4�' �.--. N . Y� P <br /> '.�r"Sc ,:;�' . � __ ' ��,?7�yQ��i,�� -��Q�,�YF1�1�,`_`�1�1��� `.r ..� � Y..��.�.�.: i <br /> (� Yes,this section applies <br /> The replacemcnt of a l2osidential fixtu,r�or applrance that meets all three ofthe following requirements: <br /> 1. TJoes not require modifieation to tlectrical or gas service. { <br /> 2, T�as a total cast of$SOOAO or less;exoludin the cost of thc fixturc or appliance:and 4 <br /> 3, Is improvcd,installcd or repiaced by the homeowner or lieensed contractor, 4 <br /> t <br /> Skip next section,'rf this applies; Cost of Permit $ 15.00 � <br /> State Surcharge � 5.00 <br /> Mail-Cn�'ee(�fApplicable) $ 2.00 ; <br /> Totai riermit�ee � ( <br /> ! <br /> � <br /> -.�-�-.����_ _� =_ = n��� ��� ��_- - -�'�` ' <br /> .'c�c 4.v�w. i �ee'i �--'. .k'=c_—. �n- ��i�� € <br /> If above does not apply;follow guidelines below: r <br /> F <br /> f <br /> 1, CONTRACT PRICE � is 1.25%of contract price wit a(Minimukn�ee of�SO.OU) i <br /> �� � ...,,.��..(.�_7 Q� , �a'�., <br /> X zV A��P...�:M1 �� e.. .�.�.-....,.�.v:. <br /> �r <br /> �C9�rraFs��r!�@): �mmimum$SO k0)t'^"^_..^f <br /> 2. STAT�SURC�AMtC� � ; <br /> �`'r�x''�,OQ�':��� ( � <br /> I�QOntr��t,Fric��? <br /> 3. POS1'ACr�&HANDLIN(�(pnly on Mail-In Applicxtions) �$� ��'.00.;:.:,:_`.,,_';� <br /> C� <br /> 4. TOTA.L P�D2My1'���(Add Lines 1-3 Abovc) �,;x� „, `� � ,��;=' <br /> � * CONTRACT PRICE or JOB C05T means the actual or estimated dollar arnount charged for the <br /> permit�ed work ineluding materials,{abor,profit,and other fixed costs. Yt is the amount to bc charg�d : <br /> to the custoCner fol'the work done. Cf any rr2aterial,equipment, labor or installations are ft►rnished by � <br /> the owner,tenant or any othcr p2ity,thc reasonable market vAlue of such'rtems must be added to the � <br /> estimatcd cost or contract price for permit fee purposes, In the event that there is a dispute on the � <br /> amount oP the job Cost,the Clty may �'equest the subrr►ission of a signed copy of the actual contraCt. ( <br /> - ; <br /> _-a�= :.���_. ` � _ -_� .�=�'�� '._��� .-�'' �`�l<_.-_--��.�r <br /> i <br /> i <br /> The unde3•signed herCby applies to the Ci#y for issuance of a Mechanical Permit, agrees to do all � <br /> work in strict accordanee with the ardinanees of the City and the regulations of the State of � <br /> Minnesota, and certifies that all statemenis made on this applicatipn are complete, true and <br /> correct. <br /> Applicant's Signature: ���"�V ��`Y��� i:Dat�;.� ' �-l' <br /> 3 <br /> , <br />