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Oct-20-2009 04:21pm From-CITY OF ORONO +9522494616 T-862 P.003/�03 F-144
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<br /> ❑ Yes,this secrion applics
<br /> The replacement of u Residenrial fixnue or appliance that meets all d�ree vf the following requirements�
<br /> �. Does not requu•e modificatiorc to�lec�ieal or gas service.
<br /> 2. Has a tntal cost of$500,00 or less;excl 'n the cost af the fixt�un or ap}��iancc: $nd
<br /> 3. Is improved,insralled or replaccd by ihe homeo,Wner or licensed conuacrru•.
<br /> Skip next secti�n,if this applics; Cost of permit $ 15.00
<br /> State Surchar�e $ _50
<br /> Mail-In Fee(If Applicable) $ 2.00
<br /> 'fotal I'ermit�'ee $
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<br /> If above does not apply;follow guidelines below:
<br /> 1. CONTRACT PRICE *is 1.25%of con�rAct price with a(Minimum�'re of$50.00)
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<br /> �DD X_o�zs$ '�D v�o
<br /> (conaac�nricc) (�ninimum 35U.U0)
<br /> 2. STAT�SLTRCHaRGE **Add the Statz 131dg Code l�iv. Surcharge(Minimum]Eee of 5.50)
<br /> x.0005 $ �• �
<br /> {COiIirACL priCd) �ininimum$ SO)
<br /> 3. p4STAGr�&HANDI.I:VG(Only on Mail-In Appiications) $__ 2.00
<br /> 4. TOTAL P�RMIT FEE(Add Lines 1-3 Above) $„���•�
<br /> ■ "` CONTRACT PRICE or JOB COST means the $ctual oT csnmated dollar amount charged for the
<br /> permitted work including materials,lAbor,profit, and othzr fixed cosis. Yt is the anwunt to be charged
<br /> to the customer for The work done. If any material, equipment, labor or installat,ons are furnished by
<br /> the owner, tenani or any otl�er parly, the reasonablz markez value of such items rnust be a@ded to the
<br /> escimated cost or con�ract price for permii fee purposes. In the event that ther: is a dispure on ihe
<br /> Amouni of the job cost, the Cicy nzay rcqucst che submission of a signed eopy o1'thc actual con�act.
<br /> - **The STATE SURCHARG�is.0005 of the Building Departmznt at(952)249-4600 for tlie pricr.
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<br /> The undersigned hereby applies to the City for issuance of a Mechanieal Pennit, a�rees to do all
<br /> work in strict accordance with the ordinanc�s of the Ciry and [he regulatiuns of the State of
<br /> Minnesota, and certifies that all statements made on this application are �:omplete, true and
<br /> correct.
<br /> Applicant'> Signature: r� r�d���"` Date: �����'�
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