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Uav-16-20Ux ;1:30am Fro�-CITY OF ORONG .y�c�.+au�� . _ <br /> � ` <br /> p��1v(T'T 16'R��' C'AY.CYT�ATiXC?t'rfS) <br /> (!Ox c�,t�S tttt� ❑Yes T3�i�s Seetitm Applias <br /> _ __ 'k�c reqlacalt�en�of a�r.sidentiai,�xture or a�►pliancc tl�at meets�ti thrca of the follawing requiz�ements: <br /> -- ---_ -_ 1�_ Does cav r�uire modl�i�tiAn t0 G1�c1�iGa1 Os gas service. <br /> 2) Has e��,,,r,,�af$SQ���or�s;c�c�ta�����of rh . - -- <br /> and <br /> 3� Is improve�, installed ar replaced vy ihe f�4mes�wner or licecsed�contractar. <br /> -- --- - ---------- $�ip-n�st-seccion:__ Cost of Permit $ i5.Of1 <br /> - -- --- —--------State Surcharge�—__„_,�...,�.,� _ -- - <br /> Mai1-'!n�'ee $ 1.50 <br /> 1�'abov�does not apply, fallow guidelines beiow: <br /> 1. C�ntr ct rice*is .O1 MS%of job with a A „�nu�Fec of(�35.QQ) <br /> ��� <br /> �- � . �� <br /> _- _--- ----- ----_ ---- � � _�Z25 $ <br /> --.--- -------- -- ---- ----- ----- _==�iwr,trnci prsce) lmsnimam S3S.� <br /> Z. State Surchar�e.** Add d�e 9tate Ataildiag Gade f�ivisior�a N�inimam l+"ee,�f���a� <br /> � ��x .Q405 $ _.../..�.��..�..�._._ <br /> (�rnract p:ice) rrr:incm�um�.SL�j <br /> 3. Pc+�a�e aad�poline(OnJ,y►raQll ln a��ndicatinn� $ t.�0 <br /> -- <br /> - --- ----- ---_____ <br /> ------- <br /> -- - - ---- --- <br /> -- <br /> -- <br /> -� <br /> ____. _ _____�.��I'A�a PERMIT FEE_iAdd lincs 1-3 abov�} $ ��� <br /> "CON['I�ACT PR7CE Ar if78 CQST':noans the aetua{or rsnmated doUer arnoanw charged fo.^rhe petm�txed work including <br /> maierials,Iabor,profit,and acficr fixed co9es.Iz iv nc�amnur,c ca 6c char�erl to che ausiam�er far thG v►ork done.If ariy mater4xl, <br /> equipmenc.lzlaor,ur instailatian ia furnisheQ by chc owner,[Pftatl:OC Qtly Mlltt j?Qtiy tI1C CC9SCIIlYlbIC tt18i'�CC[��a1ue of'such items <br /> —_ __ tCiu3 ltrPA[e�zz�sTor t`t�.urp89C�itr,���fis•'^�°•� fe-ii�4i�p�tr 83i the AmAURI-oF -- <br /> �h��ob cost,1H0 Gry h14}�l'E(�UC9t IFIE 9UISXP114St0[I OY B SP�'RCQ�p�J Of H1R AMN6I COiI[IRCE, <br /> ""Thc STATE SIJR�HARG�.is�.0405 of the contract price uFi�er$1;400,040 or$.50-whichever!s greater.For vQluatians ovcr <br /> $1,04D,00�call ehc D��atimorn of InspecAonAt Services for rl�c price. <br /> '�'hc urrdersignrd hrfeby apphes t4 the City fc��isSu�nCC Af a tafechanicai Pcxrntt,a�rees co�]o».!I wati:in ssricr accardance av;ch <br /> the ordinances of thc C:ity and tE►�rtgulntiorui af th�Minneso�a SYat�Buiiding�odc,and cert�tics�hut b[!statcments made on II715 <br /> appl;ca;ian are c4rnptete,fR]C d�ld CQIT�LC[. <br /> __ ---- --------------- <br /> — — - - <br /> . - — _ ---- <br /> ,�pplicant's Signxta�re:_ �.....,._._ --- L7ate: ',��,-���,�Uj "- - - <br /> �-- <br /> �.pproved 1�3�: Us�te: <br /> — ---- — ------- -- ---- 3 <br />