|
From:Jennifer Sinkie Fax:(888)550-5203 To:+19522494616 Fax: +19522494616 Page 4 of 1012120I2011 8:13
<br /> r � ` , „ ' �PERIVIlT I*L',L' Ct�'I�C�T1;°L I'lU�,i(�) � Ff
<br /> � ,
<br /> ,;.F�' „� , B�S.�D OFI� 2Q0� S�'�T��S�ri'1 ITJL� ' e ' ..
<br /> ❑ Yes, this section applies
<br /> The replacement of a Residentia7 tixt�u�e or a��liai�ce that meets all tluce of the following requirements:
<br /> 1. Docs not requue cnocl'ificacion ta electrical or gas service.
<br /> 2. �-Ias �total cost of��00,00 or less; excludi�the cost of die fi;:ture orappliance; and
<br /> 3. Is improved, installed or ieplace�by the homeowner or license.�l contractor. '
<br /> Skip ncxt section, if�}us applies, Cast of Permit $ 15.00
<br /> State Surcl�ar�e � SQ
<br /> Mail-In Fec(If Apglicable) $ 1.5,0
<br /> Tatal Perrnit Fee � '
<br /> , + � ��L: ����'�—�--<
<br /> '�`���<� �`;-'L'ER��1:tT:F��.N CGAL ��" �, � � ,
<br /> -- ` � (5�.-7,OBS OVER �n5:q.0"00����<�.�,�����,�-��
<br /> . . . x .+ �� f L
<br /> If aboue. does not apply; follow guidclincs below:
<br /> 1. CONTRACT YRICF *`is 1:2�%0 of contract Z�rice witli a(l�Iinimum I+e,e o.f$35.00) -
<br /> .
<br /> f �,r,..�"
<br /> / rt J ��'''' x.0125� _ —
<br /> (co�,ict psice} � (minim;im S35.OD) -
<br /> 2. ST:1`I'�> SLTI:CET.ai�(;i; 'f" Adcl the �tate Bld;; Code l.)iv, SurclZar�e (�iinimun�Fee of!�.SO)
<br /> x.000� $
<br /> (Contlact pricc) ^ � (minimum� .aU) �
<br /> 3. POS`I��\GE d'c HANDLNG(Or�ly on Mail-In Applications) $ 1.50
<br /> 4. T`OTAI,PFR:MIT`FI�:E(Aeid Lines 1-3 Abovcj �
<br /> • * CUNT'RACT PIZIC� or JO$ COS1' rncans khe actua� or estimated dollar amount clzarged for the
<br /> peiriaitteci work including rnaterials, labor;pro�t,-and,oth:er fixed costs, It is the ainount co be charged
<br /> to the customer for the work done. If any niatexial, equipment, labor or itistallations are furnishcd by
<br /> tlie owner, tenant or any other parLy, the reasonable market value of such iteii�s inust be added tq the
<br /> esrimated cost or contxact price foi pet�ut fee put�ascs. In tlie event'that there is 'a dispute on th� '"'
<br /> amount of the job cost, the City n�y rcguest 1he subnussion of a signed copy of khe actual contr�ct;
<br /> ' '�*The�TATE SURGHARGE is ,OQ05 of the Btulr�ing Department at.(952) 249-�1600 for thc price.
<br /> y?;.;�F,�c. �i[i�vt.4�n+,}N��t+l4irj j� {J�.���1�'����� s { r < t 9 '`" t � yP i . .. �
<br /> ..�., w, '\� ��R..t1�I�.T��':�'LZCA,'I"��C�'N}AG�EME��,�-����,�����`��i�-��
<br /> The undersi�ned hereby applies to'the City for issuance of a Meclianical Peniiit; agrees to do all
<br /> work in strict accordance with the ordinances of the City and the. regulations of. the State of '
<br /> Minnesota, �nd certifies that all stateme i��a�le on t ` • plication are complete, true and
<br /> corrcct.
<br /> ,
<br /> _... _ f-
<br /> ApplicanYs Si;nature: , Dat�: �"'J""G� l �
<br /> ,
<br /> .., ._..
<br /> -,
<br /> �
<br />
|