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Nov-06-2006 02:29pm From-CITY OF ORONO +9522494616 T-007 P.004/004 F-186
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<br /> ❑ Yes,this seciion applirs
<br /> '�l�e replaceinent of a Residential fi�:ture�r appliance ti�at meets all tluee of tlie following requiremenrs�
<br /> 1. T�oes noe requirz modificAtion r.o elecrzicAl or gAs service.
<br /> 2. Has a tatal cost of$500.00 or less;exclu in tlae cost of the fixture or appliance: and
<br /> 3. Is unprovecl, insTalled or replaeed by the homeowner ar liccnsed contractor.
<br /> Skip next s�cuon,if this appiies; Cost of Aernut $ 1�.00
<br /> Stsice Surcharge $ .50
<br /> Maii-Yn�ee(Tf Applicable) � 1.50
<br /> Total Permit k'ee $
<br /> ti�: o{ .�Yil r• PI� �( �ts-� . i i�7�1 i 1/r� 7 i i {� (f� "�� !I�+ � 1 ��,�. d i t �i i
<br /> �� �' -� 1JFa'�i,�,�#�' � ' !�y� �� ��y I ���i�l��r'�' ;i il', �w��� �F��' .'if��,�f���H��'!�47��� }�����.kP:��� �������;'� �� ���-i��:��
<br /> lf�.�Uf'n.q�I�l.,..<<��rf�l.`�'•'��k����7f—' � }fT�'��'1 {� .� ",n 1. � I,. ��� .!l�..�i.�l11�u h:��
<br /> If above does not apply;foilow guidelines belo cv:
<br /> 1. CONTRACT pRTC� *is 1.2�%of contract priee with a(MlnFmum Fee of$35.00)
<br /> i�oC� � oo �.0�2�$ 3�.����
<br /> (cantracc pnce) (minicnam$35.00)
<br /> 2. STAT�SC7RCT�ARG� '""`Add�he Stste Bldg Codc Div. Surcl2arge(MfnEmum Fee of�.50)/
<br /> ��� E� x.000s $ � `�ia' .—�`�
<br /> (contrac[pricr) (ttlini:Tlum$ .SOj
<br /> 3, POSTAGE &HRND�.ING(Only on Maii-in Applicarions) $ �s6 � . �``�
<br /> 4. TOTr1T,p�1ZMTT��E�(Add�.ines 1-3 Above) $ ��� ��
<br /> • "' CONTRACT �ktICE or JOB COS�' naeans the actual or estimated dollar amoun� charged for the
<br /> pennirted work including materisls, labor, profit, and othcr fixed costs. It is the amount to bz chsrged
<br /> to the customer for the work done. If any n�terial, equipment, lsbar or iz�stallations are furnished b�
<br /> nc� owncr, tenant or any otl�er parry, tl�e xeasonable market value of such iterns must be addec3 to rhe
<br /> estimated cost or con�caet price for permit fee purposes. In the event that t�a,ere is a dispuTe on thc
<br /> amounr of tl�e joU cost, ttie City may request rJ1e submission of a signed copy of the actual contract.
<br /> • **The S`�'A�'&SURCH.r1,RGE is.00OS of the Buildi�Deparrment at(9�2)249-4600 for tl�e price.
<br /> M1. in. d' Pi 1E I'�7:i11. F' i [' �� �� i�� � '�'� � 9•r11 �,�� ai �iF,�
<br /> f.� '.��iluN�,,�iS�,��' �hi n,.�� ' il�. •�� 1` � '':r�'� � �� ,'�p�'���J' ��r �� ,.'�' �r .,.t�,'' ` 'i: r �����d.t�I,�{f�s�I��, , .c
<br /> it�� !iVu,, t, �'9,.�s,. . � . . _` � ,� � �� � I:: , 9 u 1�, dfli 1 1,7� AL� .i
<br /> The undc;rsi�ned hereby applies to the City for issuance of a Mechanical Permit, agees to do all
<br /> vvork in striet accordance with the ordinances of the Ciry and the regulations of th� State of
<br /> lv�innesota, and certifies that a11 statements made on thia applicatzon are compl�te, true and
<br /> conect.
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<br /> Applicant's Signature: ; i Date� T�
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