Laserfiche WebLink
10/19/2012 14:e3 7635354379 GOLDEN VALLEY HTG PAGE 04/04 <br /> . . <br /> ct-18-2012 11:50am From-CITY OF ORONO +9522494618 T-T56 P.004/004 F-219 <br /> I <br /> ❑ Yes,ih,is secuon applies <br /> 1bc rcplacement of a Resi�entiel�ixture or�pplia�ce chat mcets a11 three of�e follow�n�requiremenss; <br /> 1_ s ot requiro modificetioa to elaCti�cal or gas service. <br /> 2. Has a to 1 c of$500,00 or less;axcl � riae coat of the 5xture or ap}�tiance:and <br /> 3. Is itnproved,installed o�replaced by�he hameowner ar licenseQ co�vactur. <br /> Skip ncxt secaon,if chis applies; Cost of P�ruiit �__ I5.o0 <br /> Sarto 3urc3�arge $�� <br /> Mail-In Fee(Yf Applicable) $ 2,Ap <br /> xotal Permit�'ee g <br /> _ '� <br /> If abovc does not agply;fallvw guidelines below: <br /> 1. CONTRACT P CE s is 1.25°/u af coatra.c2 price wlch a(Minimum�'ee of 590.00) <br /> SDC�D,DI'� X.a�zs$__ � � C� <br /> (eonttact pricc) p(unimu m SS0.00) <br /> ?. STAT��CxARGE /� q,� C <br /> �`��,Vv x.0003 $ �� <br /> (aonuact price) —- <br /> 3. POSTAGE�IiANDC.�IG(Only on Mail_In,q,ppliaeria�) $� 2�p <br /> 4. TOTAL P��2MiT fi'EE(Add Y.incs 1-3 Above) $ , �O <br /> � <br /> ■ * CO1VTFtAC'T PRICB or J�B COS�'�oae�s the actual or esam�;ed dollar amr.unt charged �ox rk,� <br /> permitced work inclading ruaTeriels,]abar,profi�,and othet fixed costs. Ii is the sinount ca ba tbarged <br /> rn rhe austamer foc the woz�;done. Tf aay mate�ial, equi�meut, labor or installad�ms are fiu�ruished by <br /> � owi¢er, r,ei�t or any other pazty,the raasonsble mar�ket vahie of auch iums niust be added to the <br /> estimared cost or eon�racs p�ce for pezzaui�fee putposes. In th� evenT rh$t therc �s a dispute rna t�e <br /> amount of rhe job cost,t� Ciry may zequast the submission of a signed copy of the actual cop�acc <br /> xhe undersigned hereby applies tQ fhe Ciry foc i99uanc� of a M�hanieal P`eraait, agret6 ro do all <br /> work in sai.et accordanee wltk thc ordinances of the C�iy and rhe regulario7�s ot rb�e Staie of <br /> Minnesota, and cercifies �Iiat all stat�men�s made on this applioativn are cumplete, true and <br /> correot <br /> � � � ( I1� <br /> Applicant's Signature; Date: <br /> 3 <br />