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0 GT/22/�012/MON 09: 09 AM Budget Plumbing �orp FAX No, 763-537-4730 P, 003/003
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<br /> ❑ � Yes,this section applies
<br /> The replacement of a Residential fixiure ot applianee Zhat mee[s all three of thc foUowing rcquirements:
<br /> 1. Does not require modification to elecCrical or gas serviec.
<br /> 2. TTas a total eost of$500.00 or less;exeludin2 thc cost of the fi�ctiue or appliance:and
<br /> 3. Ys impro�ved, installed or replaeed by thc homcowner or licensed contractor_
<br /> Skip ne�i section,if this applics; Cost of Permit $ X 5,00
<br /> State Surcharge $ 5.00
<br /> Ntail-Tn Fee(Xf Applicable) $ 2.00
<br /> Total Permit�'ee $
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<br /> � i _ a� t" hF, ,�.�Y �t V ��.i ''�',� ,y,x � ;�$�!�' „} . ,� .
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<br /> Yf above does not appl�+;follow guidelines bclow:
<br /> 1. CONTRACT PRICE x is 1.25%of contract price with a(1Vlinimum�'ee of$50.00)
<br /> ��l�� x.0125$ ��
<br /> (Co�i[rdCt priCe) (minimum$50.00)
<br /> 2. STATE SURCHAl2C� �
<br /> / y�� x.0005 $ �
<br /> (convact price)
<br /> 3. POSTAGE&HAND�.Y'NG(Only on Ma'rl-Yn ApplicaLions) $ 2.00
<br /> 4. TOTA�p�Y2MYT�E�(Add T.ines 1-3 Abo�ve) $
<br /> � � CONT�2ACT PC�CE or J"OH COST means the actual or estimared dollar arnount charged for the
<br /> pewmitted work lncluding materials,la.bor,proft,and other fixcd costs. It is the amount to be charged
<br /> to the customer for the'worlc done. Yf any material, equipmcnt, labor or installations are furnished by
<br /> ihe o'wner,Lenant ot att�other parry,the reasonablc market value of such items must be added to the
<br /> esirmated cost or conTract price for petmit fee purposes. In the event that there is a dispute on the
<br /> amount of the job eost, the City may requcst thc submission of a signed copy of the ac[ua1 contrzct.
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<br /> The undersigned hereby applies to the City for issuance of a Mechaxucal permit, agrees to do al1
<br /> work in strict accordance vuitll the ordinances of the CiCy and the regulations of the State of
<br /> Minnesota, and certifies that all staternents rnade on this application are complete, true and
<br /> correct_
<br /> Applicant's Signature: bate: l�� Z a— �Z--
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