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� ` <br /> Feb 19 2010 10: 34RM STEWRRT PLUMHING 7634281733 p. 4 <br /> ��������`�'��'�,S} <br /> I�3'1��C3k"�- ��7�, �"�'�'I'�5,".�`��'UE': . <br /> ❑ Yes,this saction applies <br /> The replacement of a Residenpai fixhue ar apnliaflce thet meets all ihree af the following requirements; <br /> 1, not require modif'ication!o elecOrical ar gas service. <br /> 2. Has a to of$SOO.QO or less;excl ' t�e cost of the fixtvre or applimtce: and <br /> 3. Is improved,installed ar t�eplaoed by the homeowner or]icensed cantracoor. <br /> Skip cuext section,if this applies; Cost of Pern►it S 15.00 <br /> State Surchstge $ .50 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Pernut Fee � <br /> F�',' Y �'� �`.,, '� .�����'� �.����(�0+,�?` <br /> If above does not apply;follow guidelines below: <br /> ]. CONI'RACT PRICE *is 1.25°Yo of conhact price with a(Minimnm Fee of 550.00) <br /> �D1��•� x .O125$ ��� ZrJ <br /> (uone�sd prico) (mimmum sso.00> <br /> 2. STATE SUI�C"HAR�E **Add the Sfate Bldg Code Div. Surcharge(Ibi'mim�un Fee oP 5.5�) <br /> �,�ex�.c� x.c�oos $ �3.25 <br /> (c:oavactpriae) <maimum S .SO) <br /> 3. POSTAGE&HANDLING(Chily on Mail-In Applications) � --�fl6�" <br /> 4. TOTAL PERMT�FEE(Add Lines l-3 Above) $ � 1�FJ� <br /> • • CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the <br /> percnitted wock including matecisls,labor, prafit, and other fix�ed costs. It is the amount to be charged <br /> to the customa for the work done. If any met�ial, equipment,lebor or instellations are fumished by <br /> the owner.t�nant o�any olh�er party, the reasonable market value of such items must be added to the <br /> estimated east or contrAct price for permit fce pwposes. In ihe eve,nt that thei�e is a dispute on the <br /> amount of thc job cost, the City mary zequest the svbmission of a signed copy of the actuel contcact. <br /> ■ �`+`The STATE SURCHARGE is.0005 of the Building Deparhncnt at(952)249-4600 for the price. <br /> 1��`��.4'(�,." "';�' ' 1�'F�;I�i4�'�`�(�?'�i.�1���`�T�' : <br /> The undersigned heraby applies to the City for issuance of a Mechanical Permit, agrees to do all <br /> work in striat socordance with the ordinances of the City and the regulations of the StaGe of <br /> Minnesota, and certifies that all statements made on this application are complete, true and <br /> correct. <br /> Applicant's Signature:��f��__��`'��� Date: Zl)q /� p <br /> ��fl� <br /> - 3 <br />