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06-06—' 16 11 :43 FROM— FIRESIDE T-083 P0003/4044 F-568 <br /> . , � <br /> '��f , 2 : ��..��r��/���V�l`1��`�+S{�) _ 4�7�,�. .3'.1 � � .Y� 2i <br /> 4 � H <br /> �1 V <br /> _ �' <br /> t °. � _ , �3����ut'��+��OQ?�fi`T�.Fa`T�S"�'A'T'C1F :` � � �``�z = <br /> -- r - _ <br /> ❑ Yes,this section applies <br /> The rcplacement of a Residen�ial fixturc or appliance that rneets all three ofthe followin�requircmenYs: <br /> 1. T7qes not require modsf►eation to electrical or gas servicc. <br /> 2. C�as a total cost of$SOO.UO or less;excludin the cost of the fixturc or appliance:and - <br /> 3. Is improved,install�d o,•rcplaoed by the homeowner or liccns�d eontractor_ <br /> Skip❑ext section,if this appNies; Cost of'Permit $ 15.00 <br /> St�te Surcharge � 5.00 <br /> M�il-Cn Fea(If Applicable) $ 2.00 - <br /> Tptal permit Fee $ <br /> _�LrJ� .^t— �w . � /�1, a. /�, r. (y, (� (�"� � 7� '����„v.::. <br /> � n �4 r �_.._ Y�� '!''M�. . \ 1°urs'� L.�f��i ' c��V.oaNHa zx�'��� . -.�$'�� <br /> tiSr+':rN,.'`_..-,�,y,x,}2� � __ , <br /> If'above docs not appiy;fo3low guidclines below: <br /> 1. COl�CTTtAC'T'PRICE *is 1.?S%of contract price with a(Minimum�ee of$50.00) <br /> �� /� (/ D <br /> � �7` x,0125$ _L�i� ' <br /> {contraGt p�icc}` {mfn3mum 550.00) l <br /> . 2. STAT�S�IRCHARC� . �0�� <br /> x.0005 $ <br /> {Contract priCe) <br /> 3. POSTAGE&HAND�,1Nr(Oniy on Mail-Tn Applications) $._�'2.0 � <br /> � <br /> 4. TOTAL Y��iMIT FEE(Add Lines 1-3 Above) $ <br /> � "` CONTRACT PRiC� or 10B COST means the aotual or estimated doll amount charged for the <br /> permittcd work including materials,labor,profit,and other fixcd costs. 7t is the amounC to be charged <br /> to the customer far thc work done. If any material,equipment, labor or installations are furnishcd by <br /> the owner,tenant or any other parry,the reasonablc market vatue af such items must be addcd ro the <br /> estimated cost or eontract price for permit fec purposes. Tn the cvent that there is a dispute on the <br /> amaunt of the job cast,thc Ciry may requtst the submission of a signed copy of the actual contract. <br /> �+ �TY yy y�J' TTj"� ,(� �T�7`�,�,c�� ��, <br /> x 1 .E�1 ����" �.'(�qg ��LT�yI�:jL�.k�l'Sb.�.l�<1� ��'_1.l�.'d�-:�.x3�'*°��(Li.�ttl°'�k� 2iU . <br /> �d}.._�_:r,t..<;i�'f.._.,.��fr.�.M_.. ..��+L� . <br /> The undarsigned hereby applies io the City for�ssuance of a Mechanieal Permit, agroes to do all <br /> work in strict accordance with the �rdinances of the City and the regulations of the State of ; <br /> Minnesota, and certifies that all statements made on this application arc complete, true and � <br /> correct. <br /> /� i <br /> Applicant's Signaturc: ' ^ bate: W /� , <br /> � <br /> I <br /> 3 � <br /> i <br /> � <br />