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� 12-08-' 15 14:40 FROM- T-473 P0043/4007 F-827
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<br /> :>�- _ - > ` .;:�Y �3�'�S�UFF� ,��Q2�5'Ir�,`I',��'1�1I`�T.�, - �'-''�L-`r -- '>> _-
<br /> ❑ Yes,this section applies i
<br /> The replacement af a�esidential fixture or appliance thst meets all three of the following requirements: �
<br /> �i
<br /> 1. Does riot require modifieation to electrical or gas service.
<br /> 2. Has a totAl eost of$SU0.00 or less;excludin�the cost of t11e fixture or ap�liance:and
<br /> 3. Is impraved,installed or rcplacetl b�Yhe homeowner or licensed contractor. .
<br /> Skip next section,if this applies; Cost of Permit � 15.00
<br /> State Surcharge $ 5.00
<br /> Mail-Tn Fee(rf Apr�licable) $ 2.00
<br /> Total Permit�ee $_�,__
<br /> z �' �,,. D TA�T 7r,}r.,�,_ (��'l,.T, or-.�r(�'��!'�-�--� :J i /1 �yrc acd.���t�a4;`_i .
<br /> 13-`','c���?a._a_� :*'�!�.!:Y`-�A'G'��1A.,� .��.�E" w�^.�,���1��'��IV���j .�4���0 ll��irt -�-.��:c4K"�.� ��,
<br /> Tf above does not ap�ly;foUow guidelincs bclo�v:
<br /> 1, CONTRACT PRICE *is I.25%of contract pricc with a(Minimum�ee of 550.00) ;
<br /> �� 1� ��:T�12S$� ; `. ,-_'� €
<br /> {c§ntract_pri�z2; �(nninit�um�SO RQ); !
<br /> 2. STATE SURCT-YARC� � �'� `��j . �
<br /> � �x!;�00�`!''�;
<br /> �rir�A��.Pt1S�5�� :
<br /> 3. POSTACrE&Y-IAN�7LCi�IG(Only on MAiI-Yn Ap}�licatipns) ��; _; ��^';��5.�.".,s-,�-.�,'
<br /> ; ,:. _
<br /> 4. 'T'OTAL PERMIT���(Add LinCS 1-3 AbOve) ��$r''` ,r ,'i
<br /> + + CONTRACT PR�GE or JOS COST means th� actual or esticttated dollar amount charged for the I
<br /> permitted�vork including materiafs,labor,profit, xnd other fixed costs, yt is the amount to be eharged
<br /> to tl�e customer f'or the work done. ►f any material,equipment, labor or installations are furnished by
<br /> thc owner,tenant or any otl�er party, the reasonable market value of'such items must be added to the
<br /> estimated eost or contract price tor permit fee purposts. In the event that d�ere is a dispute on the
<br /> amount of the job cost,the Ciry ma� request thc submission of a signed copy of the actual contract.
<br /> �s-�C F���de��-��1. +.."�'� � ° ��.F'����� 5��11.t���kk�`i����r�..��'z,a.�L":?'�'.�i3t�-��:
<br /> The undersigned hereby applies to thc Gity for issuance of a Mechanicfl] Permit, agrees to d4 all !
<br /> work in strict accordance with the ordinances of the City and the regulfltions of the State of �
<br /> Minnesota, And cei�ifies t}iat all stAtements lnade on this ap�lication arC Coa►plete, true and i
<br /> COn'ect. �
<br /> !� �.fl`t�B�Y'��9�i,�-t�-f _, r
<br /> Applicant's Signature: _ � �,nate�:' L �
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