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46-09—'15 16:15 FROM— T-890 P4003/0007 F-079
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<br /> ❑ Yes,this secCion applios
<br /> Tha replacement of a R�is►ential fixture or appliance that meets al1 three of the following requirements: .
<br /> 1. Does not require modification fo electrieal or gsas serviee.
<br /> 2. Has a total cost of$500.00 or loss;excludi�the cost of the fixture or appliance:and
<br /> 3. Ys improved,installed or replaced b�the homeowner or licensed contractor.
<br /> Skip next scction,if this applies; Cost of Permit $ 15.0(1
<br /> State Surcharge $ 5.00
<br /> Mail-Tn�'ee(Yf Applicable) $ 2.00
<br /> 'Y'otal�'ermit�ee $
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<br /> If above does not apply;foltow guidelines below: �
<br /> 1. CONTRACT PIt1C� * is 1:?5%of contract price with a(Minimum�ee of$50.00)
<br /> $2,22Q 20 + �,.R�`� `� '3�':��'.SI.�:QtQ. "�k`r,�;'.��4}=': �
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<br /> ?E:• .,��:+: �.'�,�,:�.. �' I
<br /> ��`�".5"��•n�s��� ����i��;an� i
<br /> 2. 3TATESURCHARGE
<br /> $2,220.20 x��.,Q�0:Q5���3 -- 1,11 ',
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<br /> 3. POSTA4E&HANDLING(Only on Maii-ln Applicadons) :,�t l2�:0��:,;`��';�::,:;�,
<br /> A. TOTAL PERMIT FEE(Add Lines 1-3 Above) �:5���:�� ;;5,�;��:1;�': �:�,'<��'•,s-`
<br /> ■ * CONTRACT PRIGE or JOB COST rncans the actual or astimated dollar amount chargtd for the
<br /> permitted work including materials,lahor,prof�t,and other fixed costs, lt is the amount to be charged
<br /> to the customer for ihe work dono. If any material,equipment,labor or installations are furnished by
<br /> the owner,tenant or any other party,tho roasonable market value of such ittms must be added to the ;
<br /> ostimated cost or contract priee for permit fee purposes. In the event that there is a disputo on the
<br /> amount of the job cost,the City rnay requzst the submission of a signed copy of the aetual eontract. �
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<br /> e �t E,R �p� i '�, P ,:�, C� .s: .4"Y�i. a ��'•,, � 4 "�-"`°`�,;,3U�t�i,�tip,�f{;.�"+�.�V�9j� i
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<br /> The undersigned hereby applizs to the G�ty for issuance of a Mechanical Permit,agrees to do all i
<br /> work in strict accordance with the ordinances af the City and the regulations of the State of j
<br /> Minnesota, and certi#ies that all statements made on this application are complete, true and �
<br /> correct.
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<br /> C.e� l�e�vy�ce-�:e� �
<br /> Applicant's Signature: ��t�s�; 6/9/15 �
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