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' E8/1I/2011 14:58 9529222434 SAVLER HUAC PAGE 04104
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<br /> � Yes,this secTion applics
<br /> xhe replacement of a Reside�t��xture or avpliance that meets all three of the f�ollowing requirements:
<br /> 1. Does not require modifcation to electrical ot'gas service.
<br /> 2_ kias a total cost of$500_00 or less;excludin�the cost of the fixture or appliapce:and
<br /> 3. Is imp�oved,installed or replaced by the kaozneowner or licensed contractor.
<br /> Skip r�ext section,i�Fthis applies; Cost of Permit � 15.00
<br /> State Surcharge $ S_00
<br /> Mail-1n Fee(��'Applicable) $ 2.00
<br /> Total�ermit�ee �
<br /> ._
<br /> ,, T , r A . J-�l�T ? �J T� ,Q�,�?�{�1h
<br /> ' ,'�. :':1 !1)i15��.k�'"�i,1..�/�� F:�,�:!"?.'' •�� �LJ.LV � `-Y����Y E.tS...:'�6JVl/�.AIQ ' 1(.li,•i ,j'!� .
<br /> If above does no[apply;foliow guidelines belo�%'
<br /> 1_ CONTRACT PRICE * is �•25%o�contract price with a(Minimum Fee of$50.00)
<br /> Z700r x_4125$ � :. J'��..,
<br /> (�oniract price) minimum$SQ.00)
<br /> 2. �TATE SURCHARGE *'"A.dd tlne St�te Bldg Code Div. Surcharge(�t;n;mum Fee of�5.00)
<br /> Z7 ot�� �.0005 S �" � --
<br /> (contract nrice) �imum S 5.00)
<br /> 3. AOSTAG�&HANDLING(Only on Mail-tn Applicatio�s) S 2.00 Z
<br /> 4. TO'�'A�L PERM[T F��(Add 1.ines 1-3 Above) � � 7 �
<br /> - W CONTRA,CT PRICE or JOS COST mear�s tt�e actual or estimated dollzr amount chargcd for the
<br /> permittcd work including mate�rials,labor,profit,and oth�r fixed costs. lt is the amouqt to be charged
<br /> to the customer fo�the wo�k donc. If any material, equipmept, labo�or i�►staUations are fiarnished by
<br /> che owner, tenant or apy other parry,the t�asorlablo market valu�of such items rrlust be added to the
<br /> estima[ed cogt or eontract price for permit fee purposes, In the event that thcrc is a dispute on the
<br /> arnount o�tbe job cost, thc City may request the submissian of a sign�d copy of thc actual contract.
<br /> • '`*The STATE SURCHF�,RtG�is.0005 timcs the Contract Arice or a minimum of�5.00,
<br /> : � ,;y G ,. : �,: .,A'��'�ti�T APPL,� A�.�or�,aG�E ;;�
<br /> ����
<br /> The undersigned heXeby applies io the City for issuance of a Mechanical Pennit, agrees to do all
<br /> work in strict accordance with the ordinanees of the City and the regulations of the Statc of
<br /> Minnesota, and certifiies that al� statennents made on chis application arc complete, true and
<br /> cvnCect.
<br /> A, licant'S SI 113LuzE: f� at�: V���rl I
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