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03-16—'15 13:51 FROM— T-612 P0003/0004 F-767
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<br /> � ,, , ,r�.,, p�� ��� ��U�. T,ION S °
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<br /> �' f �ro�r� k�'-�p A���]J� j�"���]�' �(�I, i�.7''� �7i''!'�}� ry � �
<br /> Y� ��,.�? ��-� ,�`.:�t{e� `+ �1:1 a�5? c� �A�"3Y�,?,�u3�+,..:�VV�'��AA,1�,(;'1�,4��l�,UJ-( l �'� � ��� !� 4 � r ,�M.'�' :
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<br /> ❑ Yes,this section applies t.
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<br /> The replacemenG of a ltesidential fixn�re or appliance that meets all three of the following requirements; .
<br /> l. Does not requiro modification to elecirical or gas service.
<br /> 2. Has a fotal cost oP$i00.00 or Icss;exctudin�the cost of the fixture or Appliance:and
<br /> 3, Cs improved,installed or replaeetl by ihe homeowner or licensed contractar,
<br /> Skip ncxt section,if this applies; Cost of Permit $ I5.00
<br /> State Surcharge $ 5.00
<br /> Mail-In Pee(�f Appiicable) $ ?.00
<br /> Total Permit�ee �
<br /> �'y<����,. . 'i:� �''�EIZMTT����GAL��i�'�xXC?h14S�� :;��B.S'�QU�R:$5.o0 00"' , ;,; , ;�: ��
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<br /> If above does not apply;follor�v guiclelines belo��v:
<br /> 1, CONTRACT PRICE *is 1.25%of contract price with�_{Minimum Fee of$50.00) !
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<br /> X.O125$ ��� !
<br /> (canvacc pricc) (minimum 550.00)
<br /> 2, STA'1'�SCIRCHARGE G��� �
<br /> Z` x.0005 $ ���
<br /> � ~(CUntraci pricC) • ..,.u.�-
<br /> 3. POSTAG��&�ANU�,INCr(Only on Mail�In Applications) $_ 2.00 �
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<br /> 4. `T'OTAY.P�C2My'1'���(Add Lines 1-3 Abovc) �_✓�� `�� 4
<br /> ■ * CUNTftACT PR[CE or JOB GOST means the accual or estimatetl dollar amount charged for the
<br /> permitted work including maCcrials, labor, prafit, and other fixed costs, It is thc a�nount to be charged
<br /> to the customer for the work done, If any maCtrial,equipm�nt, labor or inst�llations are furnished by
<br /> ihe o�vner,tenant or any other parry,the reaso��able rryarhet valuc of such items must be added to the •
<br /> esti►nated eost or contract price for permit fee purposes. In the event tAat there is a dispute on the
<br /> amount of the job eosf,Yhc City may request the submission of a signed copy of the actual contract.
<br /> '�'" a,Y��';;;�;s �'•�VI����N��`A�-�,E�tI�%IX'�AR�T� �A".�'�O�.N."P���EE�EN'r';`� ;� ", , '
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<br /> The undersigned hercby applies to the C'rty for issuance of a Mechanical Aermit, Agrees to clo all i
<br /> work in strict accordance wit1� the ordinances of the Ciry ancl the regulations of the StaCe of
<br /> Minnesota, and certifies that �II statements made on this ap��lication are compleC�, true and
<br /> co�yect. �
<br /> Applicant's Signatur � ~` f�ate: � I � � ✓
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