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43-11-'16 11 :59 FROM- FIRESIDE T-733 P0003/0007 F-141 <br /> - = __ .��-x � _.; -. �r�� ,,�--�=-�� , .,.�;,--- � � <br /> _ : _ , .. _ ,�. -�=:��,��� ,;•�. <br /> '��,,,5: ali�.�.g ���,y��� r <br /> �� -�e'"r�i3 �1 S e g : .� Y M.y Ij��r�r C'.'.��31'k_."x _ <br /> _ $ `�' '=% ���"-' -,:�_�_.-,..�.�.��T.� <br /> ❑ Yes,this section applies <br /> The repl�tcement of a Ttesidcntial fixturt or aQplianCt Chst mtets xll three of the following rtquirements: <br /> i <br /> 1. Does not requ'rre modifieation to electrical or gas service. <br /> Z. Has a jotal cost of$500.00 or less;excludin tht cost of the fi�cture or appliance:and <br /> 3. ls improved,installcd or replaeed by the homeowner or licensed contractor. ' <br /> Skip next secdon,if this applies; Cost of Ptrmit $ 15.00 , <br /> Statz Surchawgz $ 5.04 <br /> Mail-In Fee(If Applicable) $ 2.04 <br /> 'X'otal permit�ee S <br /> �+i� � <br /> '�'r�.+�i��v�ci Ta•`..3"'� ��.� 'i" '�?��d�:....,��3` - .`�r2�� fi '�. � �a•59C:,e i"'sc� - � ,i <br /> � <br /> If above does not appiy;follow guidelines below: ; <br /> l. CONT�#CT pY2YC� *is L25%oPcontract price wrth a(Minimum Fee of$50.00) k <br /> ,. ��� .. <br /> ;x`.0125� : ��.�. <br /> ,.(�GntiacC p�'i�c); , . (qiinimunl,$3D.00) � <br /> 2. STAT�SYJ�tCHA�tGE ; <br /> 3� x,;000s�. �� �;�" <br /> �So!?ciaix:pricc)` � � ' <br /> 3. POSTAG�&HANDLING(Only on Mail-Yn Applications) �$�� ''$!A'�':.,:`•:�' �: � � <br /> U ( �.;:-.; .• <br /> 4. TOTAC.P��tMYT F�,�(Add Lines 3-3 Above) :$ :'... : � �:�...::, :- -. � : <br /> i <br /> � <br /> ■ "` CONTftACT PRICE or JOB COST mcans the actual or estimated dallar amount charged for the ; <br /> permittcd work ineluding rnacerials, labor,profit,and other fixed costs. 1t is the amount to be charged i <br /> to Yhe customer for the work done. if any material,equipment, labor or installations arc fumished by • i <br /> the owner,tenant or any other parry,the reasonable market value of such items must bc added to the , <br /> estimated cost or contract price for permit fee purposes. Tn the evvnt that there is a dispute on the ': <br /> amount of tht job eost,the City may request the submission of a signtd eopy of the actual contract. ; <br /> � <br /> --_C. —� l _ S �� � I_�:�3T��.J a e4rT 4S <br /> t <br /> I <br /> F <br /> The undersigned hereby applies to the City for issuance of a Mechanica] Permit,agrees to do all <br /> vuork in strict aceordanee with the ordinances of the City and the regutations of the State of <br /> Minnesota, and cecti$es that ail statements made on this appiication are complete, tcue and <br /> correct. <br /> Applicant's Signature: ���V ��Gy��� 'Date: i cf" � <br /> I <br /> s <br /> 3 <br />