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10-06-' 15 16:34 FROM- T-329 P0003/0004 F-628
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<br /> ��C���ty,�fl�r�"�Y���,����rn'?���4'���^F ��j ��' � � /y�7c�,��,`r`�y � ,� �lf,�j"�c�'��� J�Y� ji 7)A�i d{-C�i+ '� '
<br /> j77 n�ly��r3�"�Y�i Gv S ��ns' °yh rl 'W��` t"Sx h(:s����*�p'��;'X�'� aa ca�+� it��t+�'S{�`�,�cn3R��'�-:�'�r"'��S�e"'AZ> e� y ��''�����' .
<br /> q h, �f?�`r j!"r,A����i'P�t"'Na t�n�!'�����''� ^�;�` , $ '?(�(� #��P � � � •(� �y ✓i a � y n �'I ��f�i�X.,.�1�� ���-.
<br /> � _�,r, h�,......�.Y? r. s'h:.i:�s'S..�,ru,r�?��!�-1����,.n7;��q1!.\i,�j„�-L�!'.+.�.��';1����;l�J�.ni *i.�3,±`..,7.r�� ,.4'r, e$ t,.i-.rC
<br /> ❑ 'Yes,this section applies
<br /> 't�he 1'e�lace►nen[of�Residential fixture or,a�plianCe thAt meets all three pf thc following requirements; ,
<br /> 1. Does not require modifieation to cltctrical or gas serviee.
<br /> 2, Has a total cost of$500.OU or less;exeludin�the cost of the fixture or appliance:and �
<br /> 3. ]s improved,installed or replaced by the homeowncr or licenscd contractor.
<br /> Sicip next section,if thrs applies; Cost of permit $ ]5.00
<br /> State Surchargc $ 5 OU �
<br /> Ma'rl-rn Fee(If Applicable) $ 2.OD
<br /> xotal PcrmiC Fee $ �
<br /> ���:SY�'��.�����9��� �����+ti.����,rf�+*l;.l%6�\�'.�.ce�e�IiS:;C?;�.07�5,7C�k'lAl.;{..r!:��(nS�lln�"C`�°r���i t�� .
<br /> 1f above daes not apply;follow guidelines below:
<br /> 1_ CONT�tAC'1'pYiYCE * '►s 1.25%of contract price witli a(Mp�imum Fee of$50.00)
<br /> /�/ �,� �C / ��C'� z ��. AFY �`y i'�
<br /> I��1 ��{N'Q��.S,.�"I�b� �JC. �t'i 1 �-.>, t. �;•2r ��
<br /> ���9�I,t�"�F4 n[ifi�1 (�i1f12.[u��t�.'F512:S?!�)''
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<br /> 2. STATE SURCHA�i�� ��r� �� (�(
<br /> � .,�,,.>•���, � I
<br /> � �c�;00Q3.'ti:�:s �.
<br /> .�9�)l�.t:��t'lRricz}J ' ;
<br /> 3. POSTAGE&HANDLING(Qnly on Mail-Cn Applications) �$��tQO�$�u=?,��-���;�
<br /> 4g , �.rK�,,.
<br /> 4. TOTAL PERMIT�'��(Add�,ines L-3 Above) �$;�;.k„',�.�� �t,,. ,�•�,;�2�s�,�`'�
<br /> ■ �` CQNT�2ACT' P121C� or YOB C�ST means the actual or estimated dollar amount charged for the
<br /> permitted work including materials, labor,profit,&nd oCher fixed costs. II is t}1e amounl to be charged
<br /> to the customer for the�vork done. If any material,equipment, labor or installations are furnished by
<br /> the owner,tenAnt or any other party, thc reasonable market viilue of such itcros must be zdded to thc '
<br /> estimatcd cost or ca�tract price for permit fee purposes. In the event that there is a disputo on the
<br /> amount of the job cost, the C;ty may request the submission of a signed copy of the aetual eontract. �
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<br /> .!_� �7�.. l: �i��.?:7.�.� `r ,3���.Y,";����rr°"r�i�.`.�."'����T�e:E..�,. ��.4bd� J� �����^�2��"��C� ��+'f '
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<br /> The undersigned hereUy applies to the City for issuance of a Mechanieal pem�it,agrees to do all F
<br /> work in strict accordance with the ordinances of the City and the regulations of'the State of i
<br /> Minnesota, and certifies that all statements made on this application are complete, true and I
<br /> correct. �
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<br /> c�s�,G� r�e-t�r�� . . :.,ry � ���� ;
<br /> Applicant's Signature: w_ �pa��s_� �
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