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<br /> 'pCT-29-2W3� 15��-' � ' ,
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<br /> � � �ERM�'1'�:�C�LCt)l:A2L�S�:. .. - ,
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<br /> 2002 St�tt 8�ei� �Xes,Tt�s S�tton Appl�es ,.
<br /> . �� '('he,�ep�rtient of a�R� ae-idential flxtuee or��that,meets all three af tKe follov�ing reqtirements: ; ,
<br /> . � ` ��' j�g;n�reqaire modification fo etectricat or gas setvice• . �
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<br /> . � , . Z) Has,a:�'of,�300.00 oc lesa; � 16e ca�t of the tixturn or appliance: and
<br /> ;� � ,j ��' Ile cir repiaced,by ihe�ianernaner or licenced contraetor•. ,
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<br /> s .,��� �
<br /> . :1 ; . .., .,.. ,,•.. , 15 00
<br /> � , � Skip next section, '. Cost of Permit $ - .
<br /> , . State Surcharge � .50
<br /> � Mail In F�e � t �"0
<br /> � �� , - --
<br /> If above does not aPp1q,.[�ol�ow guidelines bdow:
<br /> � � . : . 1; Cantract Pr1�'' is .O i 25 96 of job with a 1NinimtM++ �ee of($ 5 1
<br /> . ` �13,�8.2 xA123 S� ��"71.43 .
<br /> , (contract price) (minimum$35.40)
<br /> 2. State Surchar¢e.*"`Add the State Buiiding Code Division a(M�nimnm Fee of$.50)
<br /> � �/3��sZ a .0005 � ��7
<br /> � (oantract Price} (m3nirnum S.50)
<br /> 3. ��sta�e�.,nd�� (O�1Y mai(-in applicdtions) $ 1.50__
<br /> 4. TOTAi:.PERMIT�EE (Add iines t-3 above) , � ��`7.8? �
<br /> ;, , * COM'RAC't' PR10E or,�OB COS'� means the actual � esthnated doll�r amaint charged for the pe�mitted wi►ric
<br /> )nclwding materlais,labur.pto(it.a�nd o�er Fixed costs. 3�is the smouM to be cbar�ed to the custom�r for 16e wore.
<br /> done. If any m�icrial, e4ui�m�t. labar,or mafelletion are furnlsAed by the owner,, tenanl or arry other parfy
<br /> ' rrasanabie market vsiue of such ikms must Ue added,ro the estimakd rnst nr contract price ta penmit fee.
<br /> purpoy�s. {n the eYent that there'is a dispute on the amauat of tb�jnb rnN, the City maY repiitst the submissbn
<br /> �f a sfgned copy af the actual coritract.
<br /> f• The STATE SURCHARa� � .0�� of the o�ntract prlce under �I,000,00(� or 5.50-whichever is grester.
<br /> For vaivations over$!,W0,400 cali the DepaAment of Mspedian Serviees for the pricc.
<br /> The undersigned hecebY apPl"ies to the City for issuanc�e� re'��� F�heits�t�of Minneso�taWand
<br /> in strict accardance with the ord�rrdnces of the Caty an �
<br /> cer4ifies that a11 statements mad on t�is application ar�complete,irue and correct.
<br /> Date: /4���—03
<br /> APP19c�aYs Signatnre: ' .
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