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02-10-'16 15:45 FROM- T-655 POOQ3/0007 F-039 <br /> P <br /> � <br /> � - � 4=.; �-L,' }4 "PF�I�IT�fi�,��,�s,�°"C�� .�1�3�I���t � � � �,t z�� 1 - , � <br /> �--�'�:�r� _; �_= �``�`�A���F�;.uF�pOz=s`�'At_�?=��';���� �,� .�:' _ ?{_.,�.,. ,� <br /> ❑ Yes,this section applics <br /> The replacement of a Residential fixture or appliance that meets all throo of the following requirements: <br /> 1. Does not reyuire modification to etectrical or gas se►vice. <br /> 2. Hss A Yotal Cost of$500.00 or lcss;oxcludina the cost of the fixturc or appliancc_and <br /> 3. Cs improved,installed or replaced by the homeowner or licensed contractor. <br /> � <br /> Sk�p nexi section,if this applies; Cost of Pcrmit $ 15.00 � <br /> State Surcharge $ 5.00 � <br /> Ma11-[n Fec(If Appiicable) $ 2.00 <br /> Total Permit�ee � <br /> a <br /> `se.�,',�y.`�'_ C- ��� =r3r i°'- �-C—�--:-=_�--_---� ' <br /> _,_-r , ��.,���� ���"���-,����, ��'Z..'�` ;�:�n���;�!�.R�fi40� R�,��. �� ; <br /> Tf auave does not a�ply; follow guidelines below: � <br /> i. CONTRACT PRICE '� is 1.25%of contract price with a(Minimum Fee of$50.00) � <br /> �7��aV � X.Q12S$ "�� <br /> (conlr'act pricp); <br /> (mini�hum SSb.00) <br /> 2. STATE SURC�TARCE "L �� G� �� I <br /> f'/ 7C�...QQ�J ��� i <br /> _ 1 <br /> (contract pri�a) <br /> 3. POSTAOE&HAND�,TNG(Only on Mail-�n Applications) $' <br /> 3�-' , ` � ' <br /> 4. TOTAL PERMIT FE�(Add Lines 1-3 Above) $ . ,,�� . �� <br /> 4 <br /> ■ * CONT�tRCT PRCCE or JOB COST means tht actual or estimated dollar amount charged for the + <br /> permitted work including materials, labor,profit,and othet'fixed costs. Yt is the amount to be charged j <br /> to the cus�omer for the work done. If any material,equipment, labor or installations are furnished by � <br /> the owner,tenant or any other party, the reasonable market valuc of such itcros must bc added to thc <br /> estimated cost ar contract price for permit fee purposes. In the event that there is a dispute on the � <br /> amount of thc job cost, the City may request the submission of a signed copy of the actual contract, t <br /> a <br /> � <br /> i <br /> ( <br /> x - �� -�� t�c,�� j�' c, .ti .. • r <br /> ��,^-��..-_-�-.�K-��"`�=�r�`E�4..F�L3��.!4?``��'-7f.i_:�a: , r,b A� �'�r,�2��,„M;��r:_� � <br /> -- — - � <br /> ? <br /> The undersigned hereby applies to the City for issuance of a Mechanical Perm'rt, agrees to do all � <br /> work in strict accordanee with the ordinances pf the C'rty and the regulations of the State of <br /> Minnesota, and ce�tifies that all statements made on this application arC Compl�tC, Crue and <br /> correct. <br /> Applicant's Signature: �� �V�GY� `D�,te'�- ( " /� <br /> 3 <br />