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11-05-'14 18:31 FR4M- T-140 P0003/0007 F-255 <br /> �� t: �..�1, � f � y� �, ..Y,•. .. - c f�c� ( (,�- ++�St � � ��-r <br /> F�1 �t�'v„�`���<����af�" �; �[ By '��`�}�t�y �.�b�,��M�"�']f?"�f����•'"�;Y+'*�����„��'^c�;'���Y `�L <br /> �'"�v, y�^�`��' fk��$ks-,� ?�;�'firl��� tS���,��. � ?.,��;. !�. ���.�m `��:�'.``x�:n�,�.i+�"��� ��}�%��"�',�?�„��; <br /> Q Yes,this sccfion applies <br /> The replacement of a itesidential fixture or applisnce thst meets alE three of the fpllpwing rcquiremtnts: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. T�as a t ost of$500.00 or Icss;excludin�the c�st of the#ixture or appliance:and - <br /> 3, Is improved,installed or replaeed by the homeowner or licensed contractor. <br /> Skip next scction,if this applies; Cost of Permit $ 15.00 <br /> St��tc Suroharge $ 5.00 <br /> Mail-1n Fee(If Applicable} $ 2.00 <br /> Total Pertnit Fee $ <br /> S A r..S4� �� D �]�I (' �7' IY �r l�..y(T Q�+ (� �, ,/ c <br /> t,s��R�i 1:.AS'Sl;l U�`'4,�,��������'�A�1�Y.: ��V��.'1����k�.4�1��/f.%�G���(�����llL,a��O,t%�u�$-��`.Mij�k� �l i:Y �� <br /> ' hW? Y 1 .1, f � t� t. 3ik�'�.{ t�t;�{i <br /> IY above cloes not apply;follow guideli,�cs bclaw: � <br /> f <br /> 1. CONTRACT PR10E "' is 1.25"/0 of contract price with a(Minimum Fee of$50.00) <br /> .���.2�� x.0125� ��� ���� <br /> (contract pricn) (rninimum SSO.U(1) <br /> 2. STAT�SY1�2C�A�i�� �/} C.�.,� (�C.�- i <br /> - - ��'_ �...�x.00US � � ..,� I <br /> (contract priCe) <br /> f <br /> z <br /> 3. POSTAG�&T�ANDT.ING(Only on MAiI-In Applications) $ ,�..�U j <br /> � <br /> 4. 'C'OTA�,P�T21�1yT���(Add Lines 1-3 Above) $ C,�' <br /> ■ * CONTRACT PRICE or JOS COST means the actual or estimated dollar arr►ount chargcd for thc <br /> permitte�l work including ttlaie�'ials, labor,��rofit,and other fixed costs, It is thc amount fo be charged <br /> co the cusior�ier for the work done. Yf any material,cquipment, labor or installAtions are furnished by ' <br /> t�ie o�vner,tenant or any other party, ti�c reasonable market value of such items must be added to the � <br /> estimated cost a�contract price for permit Tee purposes. �n the eveni that there is a disputc on thc <br /> amount of the job cost, the Ciry may request the submission of a signed copy of the actual contraet. ; <br /> �' /;j�� T` �+� �/���]. T (�A� � � ��'se�' , <br /> +�'� ' n.:� ++� °1"�YwFs��m'�6�.G+ ' r.�"+��!��5.�� r��F;�.lr ;M�tiQ�k:lti�� 1� �r !.t N 1 �1 .s t�� ��?.Pf.< t f <br /> I <br /> The undersigned hereby applies to the City fpr issuance of a Mechflnical Pec7nit, agrees to do ali ; <br /> work in strict accordance with the ordinanee3 of the Gity and t}�e regulations of the State of j <br /> Miiu�esota, and certifies that al! statements made on this application are complete, true flnd ! <br /> coi�rect. { <br /> � �- � ( k <br /> Applicant's SignAture: _ Date: I � I f <br /> { <br /> 3 <br /> I <br /> � <br /> ; <br />