|
,
<br /> �
<br /> ..''� 4 S , ��—�Ti v'?}I �4x ��14 i �y� 7� *�n� �` �� � � �i,ICt� 1 ���.�� 't f� ' NI a
<br /> � dV�� � � y i � . 41 rL �{��'` 4%'�' � 4„( +�i 4 t �bg u
<br /> � ,,{� „ul 6 7 � I ; r t f;
<br /> �i i � (.�Y+i M�H ��F�� �'r ^ d-r ��i1,�64 i�0,q��Ic0 !i't����������� �u�t 9 t 'Y�Y � E 'Y k—r' i;7
<br /> � . i i �i � { r y P n� J � � c�r�y-.. w t 1 +1+ � � �.4�'�ikMii
<br /> A
<br /> �r i �; � � ��,o:'.�d�,l��� < �.�'.+C��IA�f.S'�;f,�1JG-���I.ta:,�.�1..''� ,,� �:Pa�t ; �1 , y � �,
<br /> �i. � ., ,,� �, � �. ., .�,r' t
<br /> ❑ Yus,this s�ction applies
<br /> ''1''he raplacement of a ResidcnCir�l 1 ixture or�pplianc:e l'h�C mnets all thrc:c:of tho followinb rc,yuircmencs:
<br /> I. DoGs not require modification io electrical or gas serviec.
<br /> 2. 1•las a otal eost of�500.00 or less;exc;ludini l•h�cost of the fixture or appliancr�:and
<br /> 3. !s improved, installed or replaced by lhe homeowner ur liecnsed eontractoc.
<br /> Skip nexl secCion,if thi�applics; CosL of Permit $ . I 5.00
<br /> State Surcharg� $ , 5.00
<br /> Mail-In Fee(lf Applicable) $ , 2.00 �
<br /> 1'otal Pormic Fee �
<br /> � �
<br /> �
<br /> 11'abuve does no�apply;follow guidelines below:
<br /> 1. CON'�fItAC'1'PRIC;L�. '� is 1?5%of contracc pricc with a(Minimurn i'nc ot;�SU.11U)
<br /> L f', , ['' x .o i?s� �;'�_
<br /> �Cunlruc;t prica) (minirt�wm�SU.UU)
<br /> ?. S7'ATE SURCHARGE /_.` ���
<br /> _C;''(J�i U� x.00US :� c� , O �
<br /> (contrttcc pric�)
<br /> 3. l>057'AG�6'c 1-IANDLWG(Unly on ��1.ail-!n Applications) � ,2,Q(1
<br /> 4. TOTAL I'L�ItMl7'fLL(Add Lines 1-3 Above) $ ��; ��
<br /> � * CON1"12ACT YR10E or JOB COST m�ans th� actual or estimated dollar antount ;,harged for the
<br /> pccmitted work including materials, Iabor, proEit, Find oth�r fixed costs. Lt is thn.�noui�l to bc ehHrgcd
<br /> to the cuslomcr for tlie work done. If any maderial, equipmenl, labor or insCftllations bu'e furnished by
<br /> th�owndr,tonant or any other p�rry, Ihe[easonable marknt value of such items must �ic add�d to th�
<br /> estimated eost or contract price for permit feu purposes. !n the event chat there is a.dispute on the
<br /> xmount of the job cost, 1'he City may rcquesC I;hc submission of a signed copy of thC�ictutil contracC.
<br /> �.. �.
<br /> 2 '
<br /> The undersigned hereby applic�s to lhe Cily for issuaaice of a IVl�chanical Permit, �,.�;rees to do all
<br /> work in striet aeeordance with the ordinances of the City and the rogulations oE'the State of
<br /> Minnesota, �nd cerlif�s lhat all statements made on this applicatiun arz complete, true �nd
<br /> correct.
<br /> Applicant's Si�nAture: ---,, ��, -� Dat�: ! ( ��� �
<br /> w�y{������C��y�ip,�" ��:'��''�"�rb,�+�;,; �
<br /> I1��.�h.+.�inwi:�i��wr�� L6�iiL'�li
<br /> 3
<br /> 50/b0 �Jdd HJIHI�Hl�ItJ�H JNIMO�J 9009Z6bZ96 6Z�TZ TZBZ/ZZ/ZZ
<br />
|