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02-07-'17 15:02 FROM- T-802 P0003/0004 F-973
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<br /> . Q,' y ��c` ��r� T,�il�C s F � l` 'r(�vJ"� -+�"i E.�' .�.
<br /> 1 � � r,`�f 4���e�"4 S��t a�. +zr�nan y`-"ya+3K�'a/�4k,.�cr�`.ey�tyK�:i< � �' �{h t'�j ��,'+9 5.'�'� a���t F�yy4^w'�b,� �^ ��
<br /> ��< �A1:�G11. t°`.�Y�'.3 .y�� �c��jM�F�����M�Z��,\��'�I,j,l�!.1� v�, i � ���w '��r����(`�'41�1"'��'�r4Pr� vSJh4�
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<br /> ❑ �es,this sectipn applies
<br /> Tho replacernent of a Residential fihtt�re or appliance that meets all threc of the foitowing requirtments:
<br /> 1. Dozs not require modification to electricgl or gas service.
<br /> 2. Has a cotal eosr o4'$500.00 or less;exeludine the cost of the fixturt or appliance:and
<br /> 3. Is improved,instal(ed or rcplaced by the homeowner or licensed eoniraetor_
<br /> Skip next sectron,9fthis applies; Costofpermit $ ls.00
<br /> State Surchargo $ 5.00
<br /> Mail-Tn Fee(Tf App]icAble) $ 2.00
<br /> �OtAX�Orinit Fee $
<br /> �ra> 9, �; �p'p�p���{T p (��'�}'Y„e �T �{ `�A, ��,j� (� /� j
<br /> ��?��A:fi��u�I�:iY'y�+b°�.�>J;�i�YJ.i�t�.k'( .� {7�G�YN�C��.'A�� � r�u�,��l��,b� �laE �'W �L�� �r W� �
<br /> .,F!1`. )�.'�� ! .�4
<br /> Yf abo�ve does not apply;follow guidelines helow:
<br /> 1. CONTC2A,CT PRCCE �is 1.25%of contraet price with a(l�'Zinimum Fee of$50.00 j�
<br /> C� 1 �5 X.o�25 $ ��1. ���
<br /> (ContraC[price) (miuimum$50.00)
<br /> 2. STATE SURCH'AX2C� �p � O
<br /> `'G � x.0005 $ � '
<br /> (contract price) �..,;
<br /> ,��� =�
<br /> 3. POSTACrE 8�1�ANDLING(Only on Mai1-Tn Applications) $
<br /> 5�
<br /> 4. TO'I'AL P��ilVXXT�`+��(Add Lines 3-3 Above) $ ����
<br /> ■ * CON7`T�ACT PRICE or JOB COST means the actual or estiniated dollar amount charged for the
<br /> permiited work including materials, labor,profit,and other fixed cosCs. It is the arraount to be charged
<br /> to the customer for the work done. If a�]y material,equipment, labor or installations are furnished by
<br /> the owner,tenant or an�other pArty,the reasonable market value of such items must be added to the
<br /> estimatcd cost or contract priee for permit fee purposts. In fhe event that therc is a dispute on the
<br /> amounL of the job Cost, [hc CiCy may request the submission of a signed eopy of the actuat contraet.
<br /> +:�,.;� �, }�,� TA� y�, ��_/// ��,�r,7�Te!''�p x,�-� y,
<br /> ��i€�,��a'�����i�.���'t d i�:�X��r�� h`F'�Y:3''f�; ����.'� P ��3 �'�M.�k'�F71.W.T�'1.��kY.�M+ �''Nj�. ''^�c�����y7�' {�' ��
<br /> F�Mt.XF�' l...A.,.1fi. ..� . �T' ,,V R����:rS W...�Sf��. A
<br /> The undersigned hereby applies to the City fOr issuance of a Meehanical Perm'rt, agrees to do all
<br /> work 'rn stricC accordance with the ordinances of the City and the regulations of the State of
<br /> Minnesota, and certifies that all statements made on this application ar� complete, true and i
<br /> correct.
<br /> A,pplicant's Signature: � ate: ����/�
<br /> 3
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