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�a�-13••2J04 09:2;,R Fronr;l'`' OF ORONG <br /> +95224nJ6;6 T-642 P J03/003 F-60? <br /> Y�R�uT i�'EE CA �,-�a��o� . <br /> 0 State � e � �'es, This Sectian Applies <br /> The replaccment of a R�sidential fixn��p �� �,���. n�,� �� ��ets ail three. of t?:e foilowin <br /> requiremtnts� � <br /> 1) ��es not require modification to electrical or gas service. <br /> ') Has a t t� cot of.�',5pp,pp or less; ludin the cost ofrhe fixcure or appliance; <br /> and <br /> 3> 1's improved, ir�talled or rcplaced by the homeovvn�r or liceru:ed contracCor. <br /> Slcip nexr sectio�; <br /> Cost of Pe�ie � _ _ �S CO <br /> Sta�e Surcharge � S� <br /> � MaiJ Tn �ee $ _ 1 �0 <br /> _____._.___,____ <br /> ------r----�-- <br /> If above does not apply, 1'ollow guideiines below: ~—� <br /> 1� ���Yriee'� is .0125 % of job with a :Ylinimum Fee of 3.pp <br /> ���d "e k .012s <br /> (contract price) � "-`-�-�5` D� <br /> (Ininimum S3S.UU) <br /> �. �State S�rchar �`* Add the Srate Building Code Division a (i�linirnurn gee ot'$ .50) <br /> �/��� �� <br /> �-1��LX!/(Jr_______� x .0045 <br /> (conrracc pr,ce) � - —,---a�"�� <br /> �minrmum $ .S�) <br /> =� PostaQe and Hanc�ling (p,�y mail-in applicatior.$) <br /> � --------I.S.Q_ <br /> 4� TU1'A�, PERti1TT FEL� (Add lines 1•3 above) <br /> ` CdN7`FiACT PRiCE or JOB COST means � S �' /� <br /> work including rr,aceria;s, labor,prafit,tr.d orheryr�a�os�s��I�;a�,�.�o���o�charged to the cus:omer <br /> for th� u�ork dune, 1f any ma;cr;�7, equipmzr.t, lab�r, or instaUa�ion atz�u�9hed b ��'tted <br /> ��y och�r p�y��e nnsonabie market va�ue of such items must be adG�d co the es[imated cost or cont�act <br /> y c�c owner, cenanc or <br /> pt�ce for per�niu fee purposes. In ch���•en�thac �;ere is a dispuce c>n the amount of:he joh cost, u`tc Ci <br /> r�quest tbe submission of a sigtied copy ot t1:e acn�ai contraet, <br /> c3'ra3y <br /> " The STAT6 SL'RC1�I,�1RGB is ,0005 of�:e contract rice � <br /> For valuarions over$1,000,OQp�a�� �� Dep���o of Inspe�t on 5�;1000 f� �p�'er�chcver is �reater. � <br /> Thc unclersigned hercby appIies to thc City for issuancc of a Plumbing prnnit <br /> work in strict accordance with the ordinances of the Cit and the re � agTezs to do a11 <br /> Minnesota, and c�rtifies rhat all state! ' �s d this app;ication arctcompletc,etrue and <br /> correct. <br /> Applicant's Signaturc: � <br /> �-� ----_______ Dare; <br /> � <br />