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05/31/2016 TUE 15: ia Fax 61z 8zz 5a08 A1� � Maeter Plumbimg �ppa/OOa
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<br /> ❑ Ycs,tllis scction app� .
<br /> � The replaccmcnt of a Rcsidcntial fixture o liance that meets all three of the followins requircmcnts:
<br /> 1. Docs not rcquirc modi�ication to cicctr or gas scrvicc,
<br /> 2. Has a total cost of$500.00 or Icss;cxcludin e cost of the fixturc or appliancc:and
<br /> 3, Is improvcd,installcd or rcplaccd by thc homco cr or licensed contractor.
<br /> I Skip ncxt scction,if this applics; Cost of Pcrmit � 15.00
<br /> Statc 5urchargc $ 5.00
<br /> Mail-In Fcc(If Applicablc) $ 2.00
<br /> ' '�otul�'crmit Fcc
<br /> �� ,�r�� ,� ��� , �"� �, i ��� �k��hd•"�`�������.��`.J.�����,�lUtUV,�iBi! � (��{'��Ei �5 i�
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<br /> �1 If above does not apply:follow guidelines below:
<br /> I�I 1. C�N'�'1ttA.Cx�121C� *is 1.25%of contract price wi�h a(Minimum Fee of$50,00)
<br /> '�� 5�o� C��
<br /> � x.OI25�
<br /> , (contract pricc) (minimum$SUAU)
<br /> 2. STATE SURCHARGE ��,('O � � ��
<br /> x.0005 $
<br /> ', (cOn�rBCt�7ricC)
<br /> 3. POSTAGL�HANDLING(Only on Mail-In Applications) � "�(�
<br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ `-'''� ' `� p
<br /> i ■ * COIVTRACT PRICE or JOB COST mcans the actuaI or estimatcd dollar amowtt chargcd for the
<br /> P permittcd work including materials,labor,proft,and other fixed costs_ 1t is the amount to bc chargcd
<br /> � to the customer for zhe work doi�e. Zf any materiaC.equipnnei�t.iabor o�•ic�stallatiocas are furnished by
<br /> � the owner,tenant or any other paity.the reasonable marEcet value of such i�ems must be added to the
<br /> � e�timated cost or con�ract price for pe�•nnit fee purposes. In the event thai there is a dispute on the
<br /> � amounc nf tf�e job cost, che Ciry may request Lhe subanission of a sisned copy of the accual contract.
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<br /> 'I'hc undcrsigned hereby applies to tl�e City for issuance of a Mechanical Pemiit,a�rees to do a!I
<br /> work in strict accordance with the ordinances of the City and the regulations oC the State of
<br /> Minnesota, and certifes that all statements made on this application are complete, truc and
<br /> correct.
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<br /> Applicaut's Signature: Date:
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