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4 Ju1-14-2005 12:35pm From-CITY OF ORONO +9522494616 T-301 P.003/003 F-136
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<br /> �r.�;�11•'_'a� �,�t ��ll��<<a�rdr7.,��rtt�,,i�li,(F�I) �,t P t A,�s
<br /> � Yes,this szction applies
<br /> Tue replacement of a siden � 1 fixturc or a �ance tha�meets all three of the following requirernenu:
<br /> �, po, e�not xec�uire modif'iea�Yon eo elactrieat or gas service.
<br /> 2, Has a ta cost of�500.00 ar less; xcludin the aosc of the fixture ox appliance, and
<br /> 3. Ts improved,iuscalled or replaced by the homeowncT ox licensed con�zActoY,
<br /> Cosr o�'PeiTnit $- �j'��
<br /> Skip next seerion,if�iis applies; S�tie Surchargc �—��
<br /> Mail-In k'ee(Zf Applicable) ����
<br /> Total permit�'ee S.—�-�-
<br /> n,(� � � �,°��� �a r,.:r�,��. ��,r.
<br /> ,r �� , ��;�,,I� 1v��� ��� (�I�1 ����k"`'+,'�.���r�;�''�t%:�w::��::��,
<br /> i�, I ' ��4�L$ r r 1 j'T,;�:r'kl'+rl�i1,,I t���'�, . �� �J�ir'Y.��,. .,..?�'..�, i, �;��.V,Xxti'l� ���.,;..� r:
<br /> .,�r •b..0.fl�r: �h� c. .I)ri�' .��'•
<br /> If above does noz apply;follow guidetincs below:
<br /> 1. CONTRACT PRIC� "` is 1.25%of contract price with a(Minimum�'ee of:��'0�J�
<br /> i �j
<br /> /�(Tj x.o125$ v'��
<br /> (c n�M���) (minimum�35.00)
<br /> 2. STA'I'�SURC�►R�'� **Add rhe State Bldg Code Div.Surcharse(Minimum Fee of$.50)
<br /> /(Q (�Q, � x,0045 $ � ` ���
<br /> on�racc prict) (minimum$ .50)
<br /> $
<br /> 3. POSTAGB&HANULIN�r(Only on Mail-In Applications) �
<br /> 4. T4'�'AI..PERMIT FEE(
<br /> Add�.i,nes 1-3 Abovc) �_��� �O
<br /> � "' CONTRACT P�C� ar�iB��abor,�profi�And other fixed cosu.a t is the�amount t�ogl>e hoarg d
<br /> per�n�rted work including
<br /> to the cusromer for the work done. If snY mat�xial, equipment, labor or installacions are ftiunis}�e Y
<br /> thc awner, tananc or �co��ce for permit fe�pu�P�����n the evanzCthat bere us a d'�spu e on tbc
<br /> estimated cost or con p
<br /> amount of che job cost, the City may request the subritission of a signed capy of the actua contrac .
<br /> • '�"�'Tbe STA,'�'�SURC�ARG�is .0005 of rbe Building DeParantni at(952)249�4600 for the price.
<br /> i t T �.1� 1: 1���� ;t���4�,f���i;t
<br /> � o ,� ,`��,�(, '!�j���1, �� � w . �.' �1`Ir�:'�,,!� '.�r�.I,+�A t �.q �'��.
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<br /> FP Ill�t 'r
<br /> T'he undersi�ned hereby applies tl7e�xd"manc�esi f the C�ty andcthe regulations o�the State of
<br /> wprk in stricc accordancc vv�th
<br /> M�nesota, and certifies that al] statements xnade on this applicatian are complete, true and
<br /> cOrreCt_
<br /> ' /'J �_`�
<br /> , Date:
<br /> Applicant's Si�nature:� �'""—'
<br /> 3
<br /> �7-14-2��5 ��:33 WATERTOWN SHEET METAL "�52 657 2553 PAGE:3
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