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oa/4a/zo17 TVE 7: 00 FAx 763 a73 8565 Sdbre xeating b �.r Cond �OOa/OOa <br /> � , <br /> . <br /> a � <br /> 1. CONT1tACT��� "`is 1.25%of conUact price with A(Mini�num Fee oC 550,00) <br /> � . Q X.�125$�n• ��1 <br /> (v�onirect pric;e) (minimum 550.00) <br /> 2. STATE SURCHARGE c <br /> �ID,�QS-OD . x.0005 � �0•Z� <br /> (Contnat prfce) <br /> 3. POSTAGE&HANDLING(Only on M„il-In Applications) S <br /> 4. TOTA'L�ERMIT REE(Add Linee i-�Abova) S ��e, � <br /> � ■ * CONTRACf PRICB or J�B COST maens the actual or estimat�d dollar amount charged foi• the <br /> ' pennitted work inch�ding matarials,labor,profit,and other fixed costs. It i�the�unount to be eharged <br /> to the cuatomer for the work dune. If any material,equipment,lAbor or inst�liatiuns ore furnished by tha <br /> ownvr, tCnant or any othtu party, thC ��easonabie u�arkct value of such itc:ms muet be added to the <br /> estimated coat or contract prica for permit fee purposea, In the event that theze is a dispute on�ha amount <br /> of the job cost, the City may requeat the submiseion of a yigned eopy of thc ac�ua! eontract. <br /> i ' <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees tv do sll <br /> work in atriot accordance with the ordinanccs of the �it� a�id the regulationa of the 5tate of <br /> Micuteso�a,attd certifies th�t all stat�nncats mAde oi�this application are complote,true and correct, <br /> Applicant's Signahire: �1��1 nLL✓ �a.lU.(�'tiU�iU�i� Date: '`F"3•���1 <br /> 3 <br />