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, _ 02-13—' 15 15:06 FROM— T-466 P0003/0004 F-610
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<br /> � Yes,this scction applies
<br /> The replacement of a Residential fixkurc or ap�liancc that meets all three of the following requiremcnts:
<br /> I. Does not require modification to elect.rical or gas service.
<br /> 2. Has a total cQ�t of$500.00 or less; in the cost nf thc fixture or appliance:and
<br /> 3. !s impraved,instalicd or rcplaced by the homeowner or liccnsed contractor.
<br /> �
<br /> Skip next section,if this applies; Cast of Pcrmit $ 15.00 �
<br /> State Surcharge $ 5.00
<br /> Mail-]n�ee(If Applicablc) $ 2,00 ;
<br /> Total Nermit�'ee $ �
<br /> �� �v 3=�� �x,r>„���>� �y�4'r�r^njr ��j yM..k �- T� QT ('�yry�yQ`1 r5'�(��� � �'pc� Q' (� f�(����`�, K:�', � (
<br /> �r/ lvil'r GtwNnn4�.�....���+.�+7+-k�.,.,6f��j.++l���i*f��!�M1h.�.Y.'��9•�MlZ,;'.1,l+ �,°a�iir. 7-M4'`H����IQY.Yr;�r ,,,J � �;� ?
<br /> If above docs not apply;follow guidelines below:
<br /> 1. CONTTtACT PTtYCE * is 1.25%of contraet price with a(Minimum�ee of$50.00)
<br /> `�l�V w, x,0125$_ ��
<br /> (contract pricc) (minimum 550.00)
<br /> 2, STA7'�STIRCHARCE q 2� /�
<br /> x.00OS $ �-J
<br /> (contract price) �V�
<br /> �
<br /> 3. POSTAG�&�ANl7L1NG(Only on Mail-In Applicafions) $ _7 00 E
<br /> I
<br /> l.J`� {
<br /> 4. TOTAY,��l2MT"f���(Ftidd Lines 1-3 Abovt) $ l�M� � ----� �
<br /> �
<br /> ■ * CONT�2ACT PRICE or JOB COST means the actual or estimated dollar amount chargeii for the
<br /> permitted work including materials, labor, proflt> znd other fixed costs. It is the amount to be charged `
<br /> to the custoirier for the work done. If any matcrial,equipment, labor or instaklations�re furnished by �
<br /> the owner> tenant ar any othcr p�rty, the reasoriable mArket value of such items must be added to tha ;
<br /> estimated cost or contract price Por permit fee purposes. In the event that tha�c is a dispute on ihe ?
<br /> amount of tha job cost, the Ciry may request the submission of a signed copy oi'the actual contract,
<br /> i
<br /> 1�5�%�'v 1�!.KI�.��t�,H .i�,l"rS��.����^��1...YI �.T�hl�a'TTn�.Ii�T�y���`G�����T.S���I.,f4�1�.:�'i�,TF 1�,.^ ti A)',� ��
<br /> The undcrsigned hereby applies to the City for issuance of a M�chanical Permit, agrees ta clo all
<br /> work in strict accorcl�nce �vittx the ordinances of the City and the re�ulations of the State of
<br /> Minnesota, and certifies that all statements rnade on.this application are complete, true and
<br /> co�-rect.
<br /> Applicant's Signaturc: ���-'� Date: � __ �✓ � �
<br /> �
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