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09-,�.�4-'15 18:25 FROM- T-296 P0003/0004 F-589
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<br /> � ^�` 1 v'.4 ri � ���:h,���'�t"��"�`U�C�+�C�"� ��4���.��„��.�� �+y�.t7� ��`7'af,n� �r�.,-Cr'!k���.�� .�
<br /> ���° �`# �A�^ �, �,y1�,� tix�, c�n,i¢`s t f�'��� �k � 5{r' v.��,��y�� �Cti y�r ,1� r� �fGk�r
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<br /> ,,,�:r..a,�._.,v�����4; �����.a�>��s�;�a 92����� ����h�_��.���� _�:���, r. .��r ���<����.,;�
<br /> ❑ Yes,this section applies
<br /> The replacement of a t�esidenii�,l fixture or a�,�liance that mcets all thret of the following reyuirements:
<br /> 1, C7oes not require modification ro electrical or�as service.
<br /> 2_ Has a total cost of$500.00 or less;e�F�,�d1e cost of the fixR�re or appliance; and
<br /> 3. Is improved,installed or replaced by Ehe homcowncr or licensed cocttractor.
<br /> Skip next scction,if'this applies; Cast of Pel'lnit $ 15.00
<br /> State Surcharge $ SAO :
<br /> Mail-1n Pee(if Applicable) $ _?.OQ
<br /> Tota�l Permit Fee $`
<br /> 2 r�'- ��F—�'-""t_.�q ma �1 r� r 1` t o ` ���`f-r �`a��1`,���hp 1
<br /> :$�l�,°�Y,%�'�.�.�,�h�r'�.',��`.�.�?�%,�A,T;��,� .�'i,.(��f�����-�;�1�.Sr(a1���a.��(��.������`. �.��L��;'�'„��.�.�i.<. ,
<br /> i
<br /> 1f above does not apply;follow guidelines Uelow: ;
<br /> t
<br /> 1, CONT�iACT PItICE �is 1.25%of contract price with a(Minimwn�ee of$50.00) �
<br /> 2.�C.P�2���';oi ',��� � ;�'''�r�;�,�=''..��
<br /> CRnt!'�c{Ril�.e); �t��,' ���n'�?K�"�$b,�),
<br /> 2. STATE SURCHARGE �I � Z�j �
<br /> ��� r x�060.�t::$' �
<br /> �lcoiitra���i'i�i�e)�
<br /> 3. POSTAC:E&HANDLING(Only on Mail-Yn Applications) :�$�_ �2 pQ ' ':;4; ''i4�
<br /> 4, TOTAL PERMiT FEE{Add�,ines 1-3 Above) �$:;!� .,,�',,;.�;'.;���,..,,,'•.?'.:",..`�,,�:''i �
<br /> ■ " CONTF�ACT pR1C� or 1'OB GOST mcans the actual or estimated dollar amount charged for the
<br /> permitted work inctuding materials, labor,profit, and other fixed costs. It is the amount to be charged �
<br /> to the customcr for the work done. If a►iy material,equipment, labor or installations are fiirnished by
<br /> thc owner, tenant or an�ottter r�arty,the reasonablc markct value of such items must be added to tt�e
<br /> estimated cost or contract price for permit fee purposes. In the event that there is A c3is�ute on the
<br /> amoi�nt of the jab cast,the Ciry may request the submission of a signed copy of the actual contract. !
<br /> �
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<br /> �,�nl�:�AfS��,.Sii� .�;d�7d" ,F`.'A�•� '�"'.��� �r'%��,�-�y.u,"!Ss`/..�4`;S�i���i .'�S`. .S�%��� �,fa_A..�,o'�r�.���.'.� .�l4^.�la.��n`��.4� ,..'� f
<br /> \� dY�7t
<br /> Th� undersigned hereby applies to the City for issuanco of a Mephanical Permit, 2grees to do all �
<br /> work in strict accordance with tl�e ordinances of the Ciry and [he regulaCions of the StatC of �
<br /> Minnesota, and certifies that all statements rnade on this applic�tion are complete, tr and i
<br /> correct.
<br /> ,, �, r . � 2L ��
<br /> Applicant's Signaiure: �.L�L�f'V ���ZZ'�"�� ��?���,{�9% I
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