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«Isy-3D-200Y 08:t0�� From-CITY OF OROWO +0622d04616 �-346 P.003/D03 �-067 <br /> ��VII't'FET CA��CLTLATIQN(S) <br /> �,Q�2 State St�� [� Yes, This S�ion Applies <br /> The replacement of a i t)aat m�eets a.0 three of the following <br /> r,aquircments: <br /> i} Dcxs not requine madificatian to electrical or gas service. <br /> 2) XYas a tota�_cosc of�500.00 ar less; exclusline the cost of rhe fiacture or applianca: <br /> and <br /> 3) ;s iu�proved, insta]led or replaced by the homeowner or licenced Contractor. <br /> Skip rnext section; Cost of Permit $ 15_00_ _______ <br /> State Surcharge $ .50 <br /> Mail In Fee $ i.50 <br /> If above does not apply, follow guidelines betow: <br /> 1, Cnntra�t Price� is .Oi25 36 of job wirh a M'iin�utum Fee of{�35.OQ� <br /> , <br /> �o� 95�, B° X .o1�s $ !3b� �7 <br /> (conoract price) (miaimum S3S.00} <br /> 2, Stste 3w�c�+A�. ** Add the State Building Code Divisidn a (Minirnam Fee of� .SO) <br /> lD,°IS� � � .0005 $ �J ��'�1 <br /> (cpn[ract price) (miniaium$ .SO) <br /> 3. Poeta�a_�lin� conly mail-in applications) $ �Q <br /> ._ <br /> 4. TpTpi,pF,,R.MYT FEE (Add litus 1-3 above) $ �Z � 3� <br /> �' CpNTRACT PRICE nr JO$COST means t1��ctual or eatiasateQ dollar amo�nt charrgsd for tha permitted <br /> work includiug materials�labor,proiit�and other fixod wa�s. It ia the a�mount to be cttarged to the cussomer <br /> for the work done. if an,y ma�erial,equipme�u.labor�or installatfon are furaisbed by tho owner,teuant or <br /> a�r otl�er party tbe reasonahle rnarkec veltu of suc�h items must be added to the estimated cost or contract <br /> prica for parmit foe purposes. In tbe cvent thac there ia a dispute on the amount of rhe job cpsr,the Ciry msy <br /> rcquest t�submisaion of a signod cogy of tlu:actual coauact. <br /> '�* The STATE SCJRCHARGE is .00OS ot chc contract price under$I,i�OD,000 or $.5(1-whicbever is grtacer_ <br /> For Yai�at�as over 51.000,000 calt the Qaparuneuc of Inspaction Servicea for the prlce. <br /> The undersigned hereby applies to the City fi�r issuancc of a Plumbing Permit, agrees to do aIl <br /> werk in scrict aceordanca with che ordinancas of the Ciry and the re�ulations of che State of <br /> Mian�sota, a�d certi�ies that all statements made on this applieation are complete, true and <br /> correcc. <br /> V"v1,1 WV�1' ,1� r' '�Z' <br /> �PPlicant's Signaturc: Date: � 3a <br />