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O1/14/1013 MON 10: 52 FAX 763 4'73 8565 Sa e Plumbing 6 Heating rg.]004/004 <br /> il <br /> � <br /> t <br /> � : �'�' ` ` ��..��'���,�'�..'�:.��..�.'����Y�Q����v� � 2 � <br /> __ .�','��,�,.��Q������Q��a�T}�'�'�.�"�'t�.����� �� <br /> ❑ �es, this sc;ctioi�appl�es <br /> 'I'he replapcment of a Residenfial�xture or ap�liance that meets all three of the Eollowiiig reqnirements: <br /> 1_ Does not require modificati�n to electrical or gas service. <br /> Has a total cost of$500.00' r less; xcludin the cost of tlle fixture or appliance: and <br /> 3 Ts itnproved, installed or re laced b ilie hoeneowner or licensed wntractor. <br /> Skip next section, if this ap lzes; Cosf of T'ermit � 15.0� <br /> State Surchar�e � 5,00 <br /> Mail-ln ree(Tf Applicahle) � 2.U0 <br /> 'Total�'ei�mit Fee S <br /> � <br /> __ _ . -_ -'� t. _ _ � __ ��iOD :.'�",, <br /> �'� =' i�' " '"���f a5�ve�does'r2i�£a�iply; follow guidelin belo�v: <br /> I, C:OIVTiY,�C'I'}'�2IC�; * is I.25°10 of contract price with a(1Vlinimum Fee of$SO,UO) <br /> �'�.i-`_� J...�;`; �;�.:`^___._ x .Ol 25�_ ;:.T\:l.i '`; '-.% __�__ <br /> (conlr3ct>>ricc) �(mi n I m wn SSq,OQ) <br /> i. s�rA�r�s �� �f; _ <br /> ��1. ��..,: (,.�..:---.r.000s � - ; . � . <br /> ._._.�i' �� __..__—_---�_.� <br /> - cconiract priccl <br /> 3. PO�TAGE` I�ANDLINU n!y on MaiE-In Applica,tions) $ 2.00 __ <br /> �,; . <br /> 4. T TAI�P MIT FEE(A Lines 1-3 Above) $ : �� `"� <br /> ° * CON CT P CE or JOB C� T means lhe actual or estimated dollar amount charged for the <br /> permitted ork including materials, bor, prof�t, and other fixed costs. lt is the amount to be chargod <br /> to thc cust mer fbr the work donc any rnaYerial, ec�uipment, labor or installat�ons are fumishe;d by <br /> the owner, tenant or au�� otlier party t:}ie reasanab(e market vzliae of such iteins must t�e addec! to ttte <br /> estin�ated si or contr'act ��ric:e for ennit fee purposes In the event that: there is a disPute on ehe <br /> Iamount of le job wst, the Ciry may ��equest tl�e subiuission of a si�ned c;o�y of the actual contracr. <br /> � <br /> � <br /> The imdersi�ned heret�y a�plies to t]a. CiLy i'or issua.nce of a 1vlc;cl�anical Pernzit, a�r�ees to do al1 <br /> work in strict accordance wit:h the di.nances of the City and the re�ulaf.i.ons nf t:h�� Sl:ai:e of <br /> Minnesota, and certzfies al aIl sta ments made on this application are complete, tnie and <br /> con�ect. <br /> 1 � <br /> �, � <br /> Applicant's Signature: .:,,_. .;..•,;�!�`Li:-t. _�.i� ;�i._i;��.�-1'./,.;ti;_.� Date: � . � x.j..j.(';(�J <br /> � � � <br /> � 3 <br /> I <br />