|
09-11—'15 11 :02 FROM— T-237 P0003/4004 F-499
<br /> * �
<br /> a�� ��X�`h �/ri1�}'s�A�,���L�pdSfiQ�"`�qry J�X�,��f �R f! X t1, � ��-, '��,���1�n� ���� \ti�(����1� `���M�7J�/:�.'T'�4 l.R��e,��i.,
<br /> y�Y��,�'��1�1 ti`•r``��/s'��y�� s. �I.� xr�7�1 �r.�- 1 S��'' �-�r�� . ` '�,,`ri � h -. v <�` .v��' � � .
<br /> a'� t1�S4�rc�/, �?� rY f� � y��/� r `(�, L`�n vr,v^1�C �4e h':lrr.•(Y,,1',(`m,; a'S( �"� �./ .
<br /> ��t\��.f=Y! {t'..y,.7��..��� � ��Y.���f h��4v,{Olf�?T..,�MVGY�l,�y4,.�'�'�1�Vt�'i:.�'�r� 4 �.\..� . )`r tt'��1 Y.la:��<'
<br /> ❑ Yes,tt�is section applies
<br /> The rep3acement ofa Rosidential fixYure or appliance that meets all three ofthe f'ollowing requirements:
<br /> 1. Does not rzquire modificAtion to elactrical or gas service.
<br /> 2. Has a to al cost of$500.00 or less;g c7,�J�j_t�the cost of the fixture or appliance:and
<br /> 3. Is improved,installed ar replaced by the homeowner or licenscd contractor.
<br /> Ship next section,if this applies; Cost of Per►nit $ 15.00
<br /> State Surcharge � 5_00 _
<br /> Mail-ln Fee(If Applicable) $ 2.00
<br /> Total Permit Fee $
<br /> �� /� (`.� f(\� �lj1 l�}� {/(+�) y{{y �?�f♦]{/���/�)/,�1/1�, Y�
<br /> �x �F..,l���lY�`I'�� �4 �p.. Y��,��M�tt� �.�f:� ..����\tK` .l�hM��V.�1���J/�y,fYY�`l`� %/Y�/�.��WS�',7 t C i R ^ .
<br /> r �,/ �1.t ����� �1;? fI ! ,�.� t � J d. i sr���� ��y !'�!
<br /> ,?,K ,`1�.� H �✓.,�wl.
<br /> �f above does not apply;foUow guidelines below:
<br /> 1. CONTRACT YRTC�, *is 1.25%of contract price with a(Minimum�ee of�SU,UO)
<br /> � �� .•. , {�
<br /> �.0�1�� ��.Qr��$���t� I �
<br /> .(q32�?I���i PT�cc�` (m,u�inX4tq'�SO�U�)� i
<br /> M. STAT�Sy1YiCC_CAIt�� �r �, C O� ? (� C..�Z> �'
<br /> �UI � `�J J� a::000s .$_�v+ __
<br /> t cci�tt�act pziqej
<br /> 3. p4STAGE&HANDLING(Qnly on Mail-In Applications) :$; '.2�00 `.'
<br /> 4. 1COTAC.P�1R1►111(T��lE(Add i.ines 1-3 Ahove) $;.,�:�,'+(, �;� (,��";:;,>
<br /> • * CONTRACT PRICB or JOB COST means the actual or estimated dollar amount charged for thc
<br /> permitted work including materials, labor,profit, and other fxed costs. It is tt�e a[nount to be ctiarged
<br /> ro the customer for the worl�done. Cf any material, oquipment, labor or installations are furnished by
<br /> ihe owner,tenant or any pther party, the reasonablc markct value of sucli items mvst be added to the
<br /> cstimatcd cost or contract price f'or permit fez purposzs. In the event that Yhere is a dispuCe on thc
<br /> amount of the,job cost,the City ma� request the si�bmission of a signed copy of the actual contract. �
<br /> (� A�T(� �I � Q �1f(� y(��/ �(� �Kv�y�y.�.r �
<br /> �.Y���nerT '.����i�.nr4.��.�N�il!�A�V�r.!J.�y'?� �J �'�X,���F��..^�R�ls��.�,1i �.�+,a.-�hhb-�l-Ih.��� e�'uTn; �..�,0'nf`Y'`���'"'.
<br /> 2, !�.!...t J.,/�'.
<br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all I
<br /> work in strict accordanc� with thc ordinances of the Ciry and the rcgulations of the State of
<br /> Minnesota, and ce�tities th all statements made on this applicatio�i are complete, true and
<br /> correct. � �
<br /> ' / i
<br /> Applicant's Signature: �� �`��'t•$'�"f'��aC�:'��'� � I � ,
<br /> ;
<br /> �
<br /> f
<br /> 3 �
<br /> �
<br />
|