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SEP/10/2015/THU 02; 18 PM Flare Heating FAX No, 7635423101 P, 003
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<br /> ",�Bt�SEI7 QF�'��20�2 S'I'A`TE'S`FATIJE
<br /> ❑ Ycs,this sectio�applie5
<br /> �he rep�acelt]eil[p�a e � e i� �:(tUt'C OF a lidflCe��at[Tleets a]1 thKee Of t�1Z fOIfOWit1g Ce�4UTe�qap,t5:
<br /> 1. oes not require anodification to electrical or gas service.
<br /> 2. Has a total cost of$�00.00 or lcss;excludin�tlle cost of Che fixture or applia�ie�:and
<br /> 3. Is im�roved,installed or rcplaccd by the homeowner or licenscd contractor.
<br /> Skip next section,if this appiies; Cost of Pemut $ 15.00
<br /> Statc 5urchargc $ 1.00
<br /> htail-In Fce(If Applicable) $ 2.00
<br /> �'otal Peruut k'ee $
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<br /> ��R�"�:�c:�,ct�i;AT�orT S -�xo�s'ov�x.'�soo.oa. ��,���w�
<br /> If abovc docs not apply;follow guidelizle5 below: ,
<br /> 1. CONTR�CT PRICE '�zs 1.2�%of co�►�act p�,ce witb,a(l��ip�,w��'ee of$50.00)
<br /> 7�3,39� �.o�zs� �5'� .9�{
<br /> (contact price) (minimum 5�(1.00)
<br /> 2. 5TA'fE SURCH 4.RGE Z8, ��rJ s,OOQS $ �� • �..�
<br /> (contr�ct price)
<br /> 3, POSTAGE cYc HANDLING(Only on 11�iai1-In App[ications) $ 2.00
<br /> 4. TOTAL PER:�IIT FEE(Add�i�z�es 1,-3 Abovc) $ c>� � i
<br /> ■ � Cp�I�'R,A,C�' P�C� or JOB COS'I' txxeans the actual or esdzx�.ated dollax acx�.oun.t charged for the
<br /> per�xuitted work including materials, Iabor,profit,and other fixed costs. It is thc amount to be eharged
<br /> to the customer for the work donc, If any material,equipmenc, Labor or installations are furnished by
<br /> the owner,tcnant or any othcr pariy,the rcasonabic market vaiue of sucli items must bc addcd to thc
<br /> cstimatcd cost or contract price �or perqlit fee purposcs. In the evet�t t�,at tJ�ere is a diSpute on the
<br /> amount of the job cost,the City t7;�ay cec�uest the submission of a sigiled copy of tb.e actual contract.
<br /> �'\ �'''.lwA,4V�P�k`1d4�.r�.Ui��'�tf+.����A!r:C�JikV'L`�'�CX��.A.i�a[� a..�.�� ���Yi�a% Y t.��.r,
<br /> 'Z'b.e undersi,gmed hereby appEies to the City Eor zssuance of a Mechanical Permit, agrees to do a11
<br /> work in stricc accordance wich the ozdanao,ces of the C�ry an,d the regulabions o£ tk�e State of
<br /> Minnesota, and certifies that all sCaCetlMqerlCs made on this applica�ioz� are coixx�lete, true ar�d
<br /> cozxect.
<br /> Applicant's Signature: Date: 7 ^ ��` ��
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