Laserfiche WebLink
. <br /> � ��;� �'� � �����a��� � <br /> �; T+�,�.k� �xt t ��r..��s r � � -��i r µ` � .f <br /> _ ��' _ ti..� t� ����' j4 � -��#� h� ��� ���� �.� f� � <br /> �� � .1� �� -' �'x9`'�'�T4l� �4 ���t��,� � 6 C 'd1i� _ <br /> .� ret.. .J'd�`�'#�3�r;��l� �.:. .,.?"*,.�-�y�r'�'�� f t j, e �. <br /> �'�"T'.��_ ,� ; <br /> �.� ,��.� r„ : � s.� . <br /> ❑ Yes, dus section applies ` <br /> The replacement of a Residential f xture or a liance that meets all three of the following requireinents: <br /> 1. Does not require modificarion to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less; excludi�the cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed eontractor. <br /> Skip next section,if tlus applies; <br /> Cost of Permit $ 15.:00 <br /> State Surcharge $ '_50 <br /> Mai1-In Fee(If Applicab��) �J .L �:�j <br /> Ta�al Fermit Fee <br /> _, . �.:.:., ` <br /> �,.: . <br /> , , ._�.._.. . . ,,,. ; _ _�_-___z <br /> r w;, <br /> _ . <br /> , <br /> . . . _ . � : . , . . . . .. <br /> ., .�.,: .:_.._... - ..�5- - � <br /> ..__:. a � { ... � .,�::.. .. . . <br /> : c <br /> �... <br /> . . -. ,. , � . . <br /> .. <br /> . ,» ... . , . � �� <br /> za ._: <br /> . .. ._.,. ,:.. w..� � . . <br /> � - .� ,�. -.::.... .. . � . <br /> If above�bes not a 1 � follow-guidelines below: � <br /> Pp Y> <br /> 1- CONTRACT PRIC� *is 1.25%of can�act price with.a(Miriimum�ee of$35.OQ) <br /> � ��� x.0125$ <br /> (contract price) (minimum 335.00) <br /> �• 51�1'i'�:SURC�IAR�E *� <br /> f\dd the Sta�e Bld�=Cn�ie L1i��. 1>>r�h3r^^ r. �_ <br /> J.. (l iai:r.u�z�Fee o�s.50) <br /> -----___ x.0005 $ <br /> (�o::;a;.:o;�ccl <br /> �-^:_:—_-.�" _^� <br /> 3, POSTAGE&HANDLING (Only on�Zail-In Applicar�ot2�} � JV, <br /> 1.50 <br /> ----�—__ <br /> 4. TOTAL PERIVIIT FEE(Add Lines 1-3 Above) <br /> � <br /> ' * CONTRpCT pg�CE or 70B COST means the actual or estimated dollar amount char•ged for the <br /> permitted work including materials, labor,.profit, and other fixed costs. It is the ampunt to be charged <br /> to the customer for the work done. If any materiai, equipment, labor or installatio�s are furnished b <br /> the owner, tenant or any other party, the reasonable marl�et value of such�tems;=m�t be added ko the <br /> estimated cost or cc�mtraet ixrice for permiit fee <br /> amount of the 'ob cost the Cit ma, re uest the submission of a s�ned co��of ls a di$puCe on the ' <br /> � � Y Y q <br /> � PY tb.e act�ial co�ttaet: <br /> ' **The STATE SLJRCHARGE is .UQDS of the$uildin De <br /> g partment at(952)249=4600 for the priee. <br /> w� t.� � ; � . ..,;. � ' .� i � J � <br /> The undersigned hereby appli'es to the City for issuance of a Mechanical Permit a ees <br /> work in sMct accordance with the ordinances of the City and the regulations of the Stato all <br /> Minnesota, and certifies that all statements made on this application are eomplete, true and <br /> correct. <br /> Applicant's Signature: �� C �Z <br /> Date: T <br /> 3 <br />