|
Jar-�A}`'"14, Z��9,m10: 47RM�ITY O���G �7 +9622d94616 7-1N0� 923,oz�ooP� 2-652
<br /> f
<br /> /d05" �nc% �� �
<br /> � � �' � . . � `P.CRMTT•,FEE�C�AT;CUI;.AT � ' (��"•:'.� �'-:•:!.�k;°'' '. � � ; � .
<br /> , . . � ; .��•��S�D 'OEF.�,20�12�STA��1'�.aT��`UE�:��;'����:'��•�;,��•-�:, � ' � ,
<br /> ❑ Yes,tl�is scction applies
<br /> Thc rcplycemenL of a�tc ' r e e iancc that meet5 dll T�hree of ihe following��cquircmcnis:
<br /> 1. �es requirc�rodification to electrical or�as service.
<br /> 2. H�s a ior s oF$500.00 er lcs�;t c � + Zhe cosc of�hc fixturc or&pplianct:nnd
<br /> 3, Is improved, instelled or replaoed by the homcowner or lieensed con�racco�'.
<br /> Skip ncxt s�cNon,if ihis�pplics; Cflst of Permit � _15 DQ
<br /> Srste Surchatge S�
<br /> Mail-rn Fcc(If Applicable) '�,_1 S�
<br /> 'fot91 Permit Fee �
<br /> � � �PE�R,MfT,�'�E CAL�CULA'Z'1,O,N(S)'=„J'OE�S�'Odv�R�$500:O�Q,� � ` �
<br /> If abQve does not apply;follow guidelines below:
<br /> �, CON?Ra�,T AR1CF. ' is 1?5°/�of concract p�ce with a(Mlnilbu111 Fee aP$3�.U0)
<br /> 2,200.00 X,0125 g 35.00
<br /> [cum�aec plico) (minimam S9S,00)
<br /> 3, STA'����11�CHARCE '"�add the SCai.�Bldg Code Div.Surch�Tgc(Mini�num Fee ofS50)
<br /> , 2,200.00 x .00aS g �•10
<br /> �eon�c�price) (mi���mum S .50)
<br /> 3. POS1'AGE&HANDLlNG(Only on M�il-Itt Applica�ons) S,,,�_, }_56
<br /> �. 'fOTAt i'CRMIT�C�(Add Lines 1•3 Abavc) $ 37.60
<br /> • w CONTRACf PR10E or 104 C1�ST means the �etut�l or Essimoced dollar amoui�s charged for the
<br /> permi��ed�vork in�luding macelialsr labor,proh�,And oih�r fixed eosrs. Ii is ihe am��unc ro b�charged
<br /> io ihe cusiomcr for the worlc done. fY any material, equipment,l3bor or insr�ll�tion��rz fumished by
<br /> ehc owner,t�nant or atly oclier parry,ihe reoso»able m�rkc��a1ue of sucl+ ir�ms m�,�be added so d,e
<br /> ��Ii�lta�ed cos� or e�n►rse� pr;cz for porr��i� fcc purpose�, 1n the evens thaz there ir u dispucc on �hr
<br /> �moun� of the job cos�, cbc City may request ehe submission of a si�ed copy oi tl�r ac�ual conrract.
<br /> • �'�The S7aTE SURCHARGE is.0005 or chc Buildin�DepaRmenc ac(952)249-d61�0 Tor ihe prica,
<br /> 1vL�C'HAN[CAL P1:RM,1�T APPLICATION'x�RL��c�i�NT' �
<br /> Tha undzrsigned lier�by applics to r,he Ciry for issuanc� of a Mechanic�l permii, agrees to do al1
<br /> work in sa•ict �ccordance with d�e ordio9nczs og �he Ciry and the ragularion, uf cl�e S�ste of
<br /> Minnasota, end certifie5 thal all srareme,nss made ou cizis applica�ion are coinplete, cruc and
<br /> conece. �
<br /> AAAlic�nt's Signature Date: Iw�T,��
<br /> � ca�� oq5
<br /> Reset�Form . � , ; 3
<br />
|