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<br /> �-002 Stat�,�fi�tute [�'Yes, �i'�on App�� � i
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<br /> T'bi� �r�p�acemeat af � �tesic�IItia'i=��xtu�e_�o� :a.��,1R:ianc�; t�a�i �mee� a1��1 tih��e o� .the fo,�o�g ?
<br /> r.eqi���m�nt�: - - i
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<br /> 1) ��.oes not� ���'u��modific�t,�on,���v e�le�:tr�ical or_-gas,serWiee. I
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<br /> �) Y�as�a.tota:l�cost o��5^ � :U0�o�l�s�;;�e�-�u���X� �te c��of�he f�tu.r�or a�p!11�ce: !
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<br /> 3} I� u�groved� ins�t��l"°k�d or�epla U�tr�th�iham�owner or. Ti�nc�d cont�actor. - :j
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<br /> � 51�� n�xt��c�i�; Co��,;a�f Pe�rmit $ 1,5..�} _ - '
<br /> S:�;re Sur�harge $ .,��0
<br /> �,„� �'� I�F�e � 1..,5'0 I
<br /> T�abave �oe� net app{ly, fo.�Io�w�gu�id'e�l�,nes be�l�w:
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<br /> 1,. Coatract_�[c�'�;is :01�5� l ,of j�ab�'�th a 'Ma�iumuin.�e�of_�('$�5.0�1
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<br /> �.�'�v x :0�25 $ t��a�1� 1
<br /> (con�r�c�,pr�c,�) (m��niri�um��,:,Ot'3) ;
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<br /> 2. �ta�e �iucha�t�. �''� A�id�hE Srate B��'�d���1e,L�iv��sian.�. ,a __(��u�Fe� oP$ .SO) �
<br /> `� �i�v� g .,UOa3 �► 2- �`� f
<br /> -(aoniract gricej (�umum�.5U) �
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<br /> 3,. Postag�_�d� �a�� �' (Only ma�=in appli�a�tio�) $ , , �b �
<br /> 4. TOTAL P� , :�� FE� �A�`�' �'ines 1=3 abov�) $ �-1, .�� �
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<br /> * C.Q,NTRACT PRI�E or 3OB.GOST m�ans tli�actu�l a��es_'��ma�ed iiullar aulount,ch�;g�rl'�oue the��r�tted
<br /> work�clud�g matenals,labor,gzofi,aud oxher��d'�cos�s. Is is the,aino�t�to be ch�u'�etl,to tlie,customer ,
<br /> for the work done:. If any.inat�rial,etpuipment,�r,,,or iustallat�on�are'fiuni�sl�ed�by the-own�r,�t��ant,or
<br /> a�y other,patty,the reasonafi�`e markei va�lue�of such���ms m�tst be added to tYte estit�iaIIeci cost or oor�tract
<br /> price€or permii fce pur�oses. ��th�event Chat�there�s a disput€�on fhe�rio�t Q€�the,jot�cost,the G'ity may
<br /> � reque"st th�submission,of a signed�o�,y of the xctual contrtict:
<br /> *� T'he STAT�StJ,ttCTyIARG�is.�15 of�e contract prioe undeF$1;OOU,000 or $.SU-wIiiehever is greater.
<br /> Far va�l�tions oveF,$.1;O�,EmU�call tlie DeparEment of Inspection Services�or ttle griee. •
<br /> � The unclersign�d hereb_y appl'ies to the City �or �s5�� � ce of a.Plumbing Permit, agrees,to c�o all
<br /> l worl� in strict accorc�ance with, the ordinances of the City and�the r�g�la�ions of the Sta:te af
<br /> 1Vli,nnesota., and c�rtifies,�at aIl sta.tements made on this app�lication are complet�, txue and
<br /> . correct. . , ,
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<br /> CApplicant s Signature: - - Date: �.Z 1
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