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02i07i20�1 12:16 DITTER INC � 9522494616 N0.307 D64
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<br /> �[� Yes,this scction�pplics
<br /> he replacement o�a Residei�tial f x#urc or spp�iance that meets all threx of the following requiremen[s:
<br /> � 1. a nt rCc�uire mOd(fication to electnoRl or gos scrvioe.
<br /> ?. HAF a[n[n s�.o1'$500,00 or less; din thc cost of the fixture or appliance:and
<br /> 3. �5 impix�ved,Installed or rcplt►ced by thc homcowner or licensdd conaecmr.
<br /> Ski�nqxt sectioii,if this applice; Cost of Permit $ 15•OQ
<br /> Stata Suroharge $�Q
<br /> M�il-ln Fee(If Applicable) $ l.�_0
<br /> 1 'Cotal Parmit Ree �_�
<br /> .p,..-i� ' ' i e�31 � (},, (�y�q '��l�-'rSu.i•,���:
<br /> �'�'r' ';a'°d'1'�t f:�til^��;�'A,� � �f:1h�. •I,:l� �►i •, ..i� �i57.i!l'G��ti-'�f+� i '«
<br /> If above docs nol apply;follow guideli�es below:
<br /> l. �'ONTRACT�'RTCE " i9 1.23�'o uf comract pricc with a(Minirnum 1+ee of$35.00)
<br /> �v Zsa,°r x.0125$ '?!•13
<br /> (eonvaet price) (minimom$J5.00)
<br /> 2, STAT�SURCH.a►RC� +'�Add d,�State 91d�Code piv.Surchar�e lNlinimum rce of3.54)
<br /> ` .��.So x.0005 $ • �---- �' v V
<br /> (eonveM prioo) (m�nimum$ .50')
<br /> 3. POS AGE&HANDLING(Only on Mail-ln Arplicationsl S �
<br /> d. TOTAL P�RMIT FE�(Add l.ines 1-3 Above) S
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<br /> � " CON"I'rtACT AR10E or JOB C�ST means the actu�l or e5un1�[ed dallar amount chargcd for the
<br /> permitted work ineluding m�terials, lAbor,profit,and o�ner fixed coscs. Tt is the amounc w bc charred
<br /> to the customer�'or tlie wark done. I�'Rny material,equipment, labor or installations arc furnisbed by
<br /> the owner, tenant or any other party,the reasonable m�rkei value of sueh items musi be added to the
<br /> estimet d cOsl or contreet price for permit fee purpases. In the evcnt thrat thcre is a diapute on Q�e
<br /> amounl of the job �oSt, the City msy requesc the submission of a si�ned copy of the aotual cenu•oct.
<br /> "*ThG TAT�5�U'RGHARGL�is.0003 of tlte Building Dcpnrtment at(952)2�9-460Q for the price.
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<br /> Tl,e unde"si ned I,ere�v � I�es to the City for issuance of�MecltaniCa) Permit, aQrees lo do all
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<br /> work in �rict ac:cordance with t�l�e ordinat�ces of the CiT}r and the re�ulations of the State of
<br /> Minnesota, �iid cercifie5 tliat all statemems made on this application are complece. I�rue a�d
<br /> corrcGt,
<br /> �f'l✓� Dare: Z�/'i
<br /> Aprlican�'s Signature: �
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