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03-03—' 15 16:38 FROM— T-559 P0003/0404 F-709 <br /> . � <br /> ; <br /> � <br /> � <br /> , <br /> � <br /> �a�.�Y�r �-�^^5 x��ej`a i � � l�� o ^1H�`ws �'��Slr tti '4� �`�" : <br /> � �,;•5 � ' ,� � `�"�'��.:MXT���. ��,�����{ -��'1T�QN(���) �_ �<< .� ;� , "u,� W,s� �. <br /> C ,� �l' � ,+ .`�f�$�'T�(��.T���2p���Q�Ad���Sz'r4TYj�' ', y ,t <br /> 0 Yes,this section applies <br /> The replaccmcnt of 8 Residenfial fixfurc ar s�pli�ncc that meets all three of the following requiremenls: <br /> l. �w�,���t require modification to electrical or gas sarvice. <br /> 2. Nas a total cost of$500.00 or Eess;excludin�the cost of the fixture or appliance: and � <br /> 3. Is improved, installed or replaccd by thc homcowner pr liCenscd contractor. <br /> Skip next section,ifthis applies; Cost of Permit $ 1 .�00, { <br /> State Surcharge � 5.Q0 <br /> Mail-1n Fec(If Applicable) $ 2.00 � <br /> TotAl Permit Fee $ <br /> ri�����;,�..> ,�.�y,j,'.�- ��u;rf�F��c��Gj?�:i��r(s)'�-;ross o�vE�$s�a.Q�� � <br /> a <br /> Tf above does not a�ply;follow guidelines below: � <br /> 1. CONTRACT PRICE * is 1.25%of contract price wi4h a(Minimum�'ee of�50.40) <br /> �� l��� x.0125 $., �,� (� <br /> (conuaCt pnCe) (minimum SS0.00) <br /> 2. STAT�S�RC1-rAl7C� � � �l'� � �� � <br /> � x .0005 � � � <br /> (contract price) � � <br /> 3. POSTAG�&HAND�.ING(Qn1y on Mail-In Applications) $ 2.00 � <br /> � � ,�� � <br /> 4. '1'O'Y'At,P�RM�T���(Add C.ines 1-3 Above) $ J <br /> � <br /> ■ * COTJTRACT PR[CE or JOB COST mesns ihe actual or estimatcd dollar amount charged for tl�e <br /> permirted work including materiAls, I;�bor, profit,anci other fixed cosis. Ik is thc amount to be charged <br /> to thc customcr for tha work done. If any material,equigment, labor or install�tions are furnished by • <br /> the owner,tenant or any other parry, thc rcasonabic market valuc of such items must be added to the i <br /> estimated cost or contract price for pern�it fee purposes. In ehe event that thcre is a dispute on the � <br /> amount of the job eost, the Ciry may rzquzst thc subn�ission of a signed eopy of fhe 9ctual contract. <br /> 4 <br /> "�K� ,���Tu�r ti�,f•�s. „ .��A�.��;�?��R�I!`�Z'I'� ' L�C QI� �aRE IvIE T.: ;'" <br /> � r � , , ,� A;p .��`�. � � � � <br /> � <br /> The unde��signed hereby applies to the City for issuanpe of a MeChaniCal Permit, agrees to do all <br /> work in strict accordance with che o�dinanccs af the Ciry and thc regulations of the State of <br /> Mir�nesota, and certifies that all statementS made on this applicafion are complete, true and <br /> co�-cCt. <br /> Applicant's Signature: ` ��� n�tC:r�,�J/ �� <br /> �� <br /> 3 <br /> � <br /> I <br />