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12-17-'14 17:00 FROM- T-302 PQ003/0004 F-434
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<br /> �] Yes,this section applies
<br /> The replacemcnti of a Residential fixture or liance that meets all three of the following requirements: E
<br /> 1. Doe ot roquire modification to eleetrical or gas scrviee. �
<br /> 2. Has a total cost of�500.00 or less; xcludin the cost of thc�ixture or appliance:and �
<br /> 3, Is improved,installed or replaced by Yhe homeowner or lieensed contraetor. �
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<br /> Skip next section,ifthis applies; Cost of Permit $ iS.00 �
<br /> State Surcharge $ 5.00 :
<br /> Mail�ln Fee(if Applicable) � 2.00 �
<br /> Tata1 Permit�ee $_....�
<br /> -^—.TM�r..e f�Ym�e+—rn� .rr�—�-�F➢ �."1y�� I
<br /> f�o�M9.1 .� �• '�.'. '�' (,7 }�`-7,"[� �Y a� /��/� �7 r1�r (� (� qj,,S.��. y+r� �„
<br /> Ji��.,r�r,�dx..„'5������M�NJ�;��� �.6��.���i.Y:���41A-�F-1.���1•��. �Q� ..1:.{�.�[�.I,t',`H:7,Q�l.Ai�ir.���.� �k�.Z��� � i
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<br /> If above docs not apply;follow guidelines below: �
<br /> 1. CONTRACT PCtICE * IS 1.25%of contract pricc with&(Minimum Fee o�$50.00)
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<br /> ,�-�-��.o�zs$ �---� .�
<br /> (CO�tract priCe) (minimutn SSOAO)
<br /> 2. STATE S �tCHAIiC� i I_ � � —
<br /> '" � i �_� X.0��5 $ �:r-_�
<br /> (Conhoct pYiCe)
<br /> 3_ POSTAGE Bz HAI�CaT.ING(Only on Mail-In App►ications) $ Z:9�
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<br /> 4, 'I'OTAX,P��2NIIT F��(Add Lines 1-3 Above) $�,�'
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<br /> � 8 CONTRaCT PR1C� or JOB COST r�icans the actual or estirnated dollar amount chargzd for the �
<br /> permitted work including materials, labor,profit, and other fixed costs. It is the amount to be charged
<br /> ta thc customer for the work donc. [f�ny matcrial, equipment, labor or installations are furnished by
<br /> the owner,tan�nt or any athcr parcy,the rcason�ble market value of such items must bc added to the
<br /> estimated cost or contract price for permit fee purposcs. In the cvcnc that there is a dispute on the j
<br /> amount of the job cost, Che C'rty may request the submission of a signed copy of the actual contract. �
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<br /> Thc undersigncd hereby applies to the City for issuancc of a Mechanical Permit,agrees to do all
<br /> work in strict accordance with the ordinances of the City and the regulations of the State of
<br /> MinnBSAta, and ccrCifies that all statements made on this applicatias� are cornplete, true And
<br /> correct.
<br /> A licant's Si nature: �,. Date: I ���� /
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