Laserfiche WebLink
�un •0.1 2016 z: 46PM HP LRSERJET FRX p. 4 <br /> �'� ��r � 4,e&� �} �.�'��`---,...,.•^^�.; - r . - .. . . .. r . <br /> t >r <br /> - S`y.'A�2 f t.� 1 f � , , k <br /> "ti � �,{w +��+.{� . � i c>> A R � � r h�;V� v �I � i r �� e <br /> `t�"sa, t�S ��J'r��YB" �' i ��'�(. � ��'tn:�,������"i� L t <br /> ❑ Yes,this sectioa appfies ' <br /> . � <br /> The repfacement ofa Residcntial fixture or�pliance that meets al1 three ofthe following requirement�: <br /> t. Does not require modification to etectrical or gas service. ', <br /> 2. Hes a total cost of$500.00 or less: z in the cost of che fixture or appliance: and � <br /> 3. ls improved, installed or replaced by the homeowner or licensed conEractar. ; <br /> Skip next section, if this applies; Cost of Permii $ I5.00 'I <br /> Siate Surcharge $, 5.00 <br /> Mail-In Fee(]f Appiicabie) $ 2.p0 � <br /> Total Permit Fee $ <br /> �� r �� � � <br /> .�, <br /> If above does not apply; foltow suidelines below: I <br /> l. CONTRACT PRiCE �` is 1.25%of contract price with a(Minimam Fee of$50.00} �i <br /> t���S3S� x .01255 1���.�cT I <br /> (contract A���) (minimum�Sd1,00) <br /> 2. STATF SiJRCIiAR(`.� ��5��3�� x.aoos $ �72.77 I� <br /> (contract price) ' <br /> 3, POSTAGE&HANDLING(Oniy on Mail-In Applications) $ 2.00 j <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3.�bove) � �g�3� ' <br /> • * C�NTRACT PRICE or JOB COST means the actual or estimated dollar amount charged fo the <br /> permitted wark including materials,labor,profit, and other fixed costs. It is the amount to be chafiged <br /> to the customer for the work done. If any material,equipment, labor or installations are furnishe�l by <br /> the owner, tenant or any other party, the reasonable rnarket value of such iterns must be added t the <br /> estirnated cost or coniract price for permit fee purposes, ln the event tha� tfiere is a dispute on the <br /> amount of the job cost, the Ciry may request the submission of a signed copy of the acival cont act. <br /> � I �, <br /> I�So�g xn - �r I <br /> TFie undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to d I al! <br /> work in strict accordanee with the ordinanees of the City and the reguiations of ihe Stat of <br /> Minnesota, and certifies that al! statements :nade on this application are complete, true nd <br /> correct. <br /> ApplicanYs Si�nature: Date: �!` �� ' <br /> � <br /> �t �, t` ;;�.� �.�„� �.��,a � '� <br /> `�'� � , s� . <br /> , <br /> 3 ; <br /> I <br /> I <br />