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11i01i2010 12:42 DITTER INC � 9522494616 N0.113 D04
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<br /> � Yes,chis sectioo applies
<br /> '�l�e:replacement oi�a Residenli�tl �ixtu��e�Fl;pLli�.nce that.meets flll I;hree ofthe following requirements:
<br /> 1. Dee�noc reqwire rnodiFica,tion to electrie�,l or g�.s service.
<br /> 2, Has a tot�l cost o:f$SOb.UO or less;excludin�Che cosC of�l�e fixture or appli�nce:and
<br /> 3, Is im��roved, installed or replflced by tl�e homeowner or licensed contractor_
<br /> Skip next section,if this t�pplies; Cost of.Pcrmii $ 1 _00
<br /> St�te Surchargo � 5.Q0
<br /> Mail-Tn Fee(lf ApplicAble} $ 2.Q0
<br /> ToCrl Pcrrnit Fec $
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<br /> ��:���� 1� ..�,� P�R:�rl�r:�. C�:��� ��r r� .�� ,,a ��oo: u�. ;,;�,
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<br /> if above does not�pply;follow 6uiclelines belo�r:
<br /> I, CONTRA�CT PR.CC� * is 1.25"/0 of contracc price�rrith a(Minimum Eee ot�5a.00)
<br /> �, ySo•pO x .o�,zs $ 80��3
<br /> (controcC price) (minimum$50,00)
<br /> 2. STAT�SURCH�RG1: °�"' Add tlze Sta:�e flldg Cod.e I�iv. Surcharge(Min�mum I'ce of�5.06}
<br /> ��`5� x ,0005 $ Soo
<br /> (canaacf prico) (minimum S 5,00)
<br /> 3. POS7'AC�&l�fi�NDLTNG(Only on fviail-In Aryplic4tions) � �_
<br /> 4. T07'A.L PG)tMYT r�E(Add Lines I.-3 Above) � 8S��
<br /> • " CONTRACT !'RICC or JOB COST means t�he nctu�.l or estin�a.ted d.ull�r amount charged for the
<br /> permitted worl: ineluding m�teri�ls, labor,�ro'rc, flnd otl�er fixed costs. Tl is the a��iount to be al��rged
<br /> �o the customer ('or che worlc clo�,e. 11'any maleri�l, eq��ipment, la.bor or insc�lJatians are furnished by
<br /> the owner, tennnt or�ny other party, the reason.able m�.rket value af such icems must be aclded to the
<br /> estii�nated cost or cantr�cf price for pennil fee p�►rposes. in d�e event th�t Chere is a dispu�e on the
<br /> amount of the job cost, �he Cit� may i•ec�uest the submission of s si�ned copy of the actufll contrac�.
<br /> ■ ""'The ST�IT�SURCHARGE is.0005 times the Contract Price or a minim�nn of$5.00.
<br /> ��: ., ,,, M�CGH�N1�^�lL,,l��lL,,�� ,a,a��' ;�,�.l:l(�� GR �� � �� y�G �;�;� ,�
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<br /> Tlie �mdersigned )�ereby a}�plies to tlie Ciry for issu.ance o1't�N[ecl��nical Permic, agrees to do �lt
<br /> work in strict flccorclance with th.e ordir�ances o9' che City and the regulations af the State or
<br /> Minnesota, and ceitiif�ies tl��t �tll statemencs ma.cle on illis applica�i�n are complete, U1.te and
<br /> correct.
<br /> �'�r ` rd
<br /> Applicaixt's Si�n�ture: `�� ^ bate: f //
<br /> �'�t.e' _ 'F o�,'"��,� 3
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