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Sa��. 11. 2015 3; 31PM No, 4698 P, 4/4
<br /> , �?`,r pEZtLVIL'���E,CALCi}�.,A;�",lo� 5 , " �� ,, � "
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<br /> ❑ Ycs,this seciton appl�es
<br /> The zcplacement o�'a esidcnti e or a 1� ce that mcets all three of the followi,xig requircments:
<br /> 1. 17oes not require modificati.on to eIec�ica�oz gas service.
<br /> Z. Has s total co of�500.00 or less;exclu " the eost of the fixtvre or appliance_and
<br /> 3. Is improvc�,�izlstalled or replaced b�the bomeoWner or licensed eonh-actor.
<br /> Sldp neact section,it'this applies; Cost of�emut $�S,pp
<br /> State Surchatge $ 1.04
<br /> Mail-Tn Fee(If,Applicable) $Z.00
<br /> xotul Permit�ee �
<br /> pER����c�r,.,�:aT�r��s =:ro�s Ov�t:��oo:� ;.,= ir; „ N , , ,,
<br /> Tf above does not apply:follow gtude]i1[ies below:
<br /> 1. CdNTRAC7f pRICE *zs 1.25%of co�n;traet price witb�a(Mi.nimum�ee of$50.Op)
<br /> � ���� �� x.0125� ��•�
<br /> (oonvacc PT+��') (m�aima►n SSo.00)
<br /> 2. SxATE SURC�ARGE � �,G n,.� '�
<br /> `��� x.0005 $ Q.� '�j
<br /> (contiad pricc)
<br /> 3. POSTAG�&HANDLZNG(Only o�Mail-In Applzcations) $ 2.
<br /> 4. TOT�iT.,PERM�T 1�EE(Add Lines 1-3 Above) $ �Q•��
<br /> • * CONTRACI'PRTCE or JOB COST mea�s the actual or estimated dollaz amount charged for the
<br /> p�t7rtitted work including materials,Iabor,profit,and other fzxed costs. It is the amount to be charged
<br /> to the customer for the work done. Tf any zz�aterial,�quipment,labor or installations are furnished by
<br /> the owncr,tenant or any other pazty,the reasoztable market value of such items must be added to the
<br /> estimated cost or contract price for per�nit fee purposes. In the event that there is a dispute on t}ze
<br /> amount of the job cost,th�City r�iay raquest the submission of a signed copy of the actual eontract.
<br /> .y;>: , .;:�.�,.��I•`�C.:����.(',��`�'' `'z��x"'���,4�..;�!����'�°i'?„ ���, >�� �.
<br /> ",�
<br /> T�e undersi�ed hereb�applies to the City for issuance of a.Meehauxcal Fermit, agrees to do all
<br /> work in sh-ict accorda.nee with the ardanances af tb,e City ar�d the r baulatioz�s of rhe State of
<br /> Minnesot� az�d cereifies that aII stateznents made on this application are complete, hue and
<br /> correct.
<br /> Applicant's Siguatur C� T�ate: Q �� S'
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