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11-30—'16 15:13 FROM— T-480 P0015/0016 F-583 <br /> , A � <br /> .q' �.,�'` � c✓=-� � 'Y � �` £13 , �`'1.`�,I.;h�t�Cf�J-7�rl lk-���1'J�7'�`i ti4� N,� �` �-` ._ � '�-� :'�m �� <br /> �, c � � <br /> .nc � � -. ��s,. �.. r c Y.4 ,i'� r� r � �3, r � - <br /> .. `� r�-'f��l���������'�����5`��,�:��,�{�`��(��'z` ' >-- `t� .�:�:�;' }�4� <br /> �f Yes,this section applies <br /> '�he replacement of a R�dgntial fixture�r,�ppli���g that meets all three of the following requirements: <br /> l. Does not require modification to electrical or gas service. <br /> 2. H�s a total cost af$5�0.00 or lass;excludina the cost of the fixture or appliance:and <br /> 3. Is improvcd,installed or rcplaccd by tho homeowner or licensed contractor. <br /> Skip noxt stcCion, if'this Appties; Cost of Pcrmit $ 15,00 <br /> StaCe Surcharge $ 5.00 <br /> MaiI-In Fee(TfApplicable) $ 2.00 <br /> Total Permit Fee $ <br /> . .��.. �-- � . ... 1}(1}1�1¢ <br /> , <br /> ��J�t'��K�G .����� . .����.. -.""..:- f .�.�JK�c �F ' .JMl�TL]dA�..��c..� — __ ' <br /> If above does not apply:follow guidelines below: <br /> 1. CONTT2A(:T PRICE * is 1.25%of contract price with a(Minimum Fee of$50,00) <br /> �l `7� /'��� <br /> �C��� x.o�zs$ �Y _ '�, <br /> (contract prica) (minimum$50.00) <br /> �, STATE SURCHARGE �r�r '� 5"� � <br /> � �fl x.0005 $ � <br /> (Contract price) <br /> 3. POSTAC�8c HAND�,TNCr(Only on Mail-Tn Applications) � 2.00 <br /> q Z <br /> 4. '�'OTAr.,P�TZ1�7'FEE(Add Lines 1-3 Above} $ �( � _ <br /> • * CONTR.ACT PRICE or JOS COST means thc actual or estimated doilar amount charged for the <br /> permitted work including materials,labor,pro�it,and other fixed costs. Tt is the amount to be charged <br /> to tl�c customcr for thc work done. If any material,equipment, labor or installations are furnished by <br /> thc owncr,tenant or any other party,the reasonable market value of such items must be added to the <br /> ostimatcd cost or contracC price fbr permiY fee purposes. Tn the event that there is a d"rspute on the <br /> amount of the job cost,the City may request the subrnissron of a si�ned copy of the actual contract. <br /> d /''� T .pT� r t <br /> �- <br /> ry, T,1 <br /> �fi��Y'�-Z;��'�-,'S��`��$�' � C� �'�yA. .J _ -�� . _ . � ._ 3` ..+ �F _ . .%P 3�.'?� F- <br /> '�s�^I a�:�.�.c�11. L ��si X a.M�,:_f �'�. :i: , �'.A�' ��'�� .��� 'ki:*�:�`� .��- ,(�. <br /> The undersigned hereby applies to the City for issuance of a MeChanical Permit, agre�s to do alI <br /> work in strict accordance w'rth the ordinances of the City and the regulations of the State of <br /> Minnesota, and certifies that all statements made on this application are complete, true and <br /> correct. <br /> � �� �� <br /> Applicant's Signatur�: _ Date: <br /> 3 <br />