|
03-16-'17 13:58 FROM- T-931 P0003/0004 F-128
<br /> .,-,z•u,� �,: � , ,� �..., . .. :.. ,.. ; �
<br /> , •t�� � ���• z � ' ?�ti 3'("'�� ' x �� �, �,.,. E, t`';3
<br /> �g'`�' .r�'S�, ���s f ���j���(;,�� • yd�a �;.�7tg.�..ta..r�-��r�(.% 1�F�}�•y.,.' �'�`.�`..�xr�.A �;. ��..
<br /> ����1„����f�ll'�%����f.S�SM�iin��f.•�.�+•'S•' � ..A.JJt2.?:��1'1��.' . i,K' .j,�• �•.v.. y. yVry' •k
<br /> fmt K�r�
<br /> ❑ Yes,this section applies
<br /> The rcplacement of a Resident'►al fixture or applit�nct that meets all three of the following requiremtnts:
<br /> 1, Does not requira modi�cation to eleetrieal or gAs scrvieo.
<br /> 2. Has a tatal cost of$500.00 or less;exeluding the cost of the fixture or appGance:and
<br /> 3. Ts improved,installtd or replaced by The$omeo�vner or lieensed eontractar.
<br /> Skip next section,if this applies; Cost of Permit $ 15.00
<br /> State Surcharge $ 5.00
<br /> Mail-In Fce(If Applicable) $ 2.00
<br /> ToEal Permit Fee $
<br /> �`!tt�.xJ.�;i''.�ya. z' .�^�`..�_+.?i[+t'�.....fii+i...N'{,9"a,`,11+r��/r�d:aiS;k1J . lN7�7'�•a� ' ��Q. �� O�f�a Y• -r�:
<br /> Xf abovc does not apply;follow guedelines below:
<br /> 1. CON'TItACT PRICE '•`is 1.259�6 of contract price with a(Minimum Fee of$50.00)
<br /> f �8o x.o�Zs$ 5�0.��
<br /> (cantfact priCe) (minimpm S5p.00)
<br /> 2. S'Y'AT�SC1XtCHA,RC� p- �t p
<br /> �0 � x.0005 $ V� o�
<br /> (contcact price)
<br /> 3. POSTAOE&HANDLING(Only on Ma�i]-In Applications) $
<br /> 4. TO'X'A,X,P�ItMCT FEE Add Lincs 1-3 Above $ �0 ��
<br /> � ) •
<br /> ■ * CONTRACT PRICE ar 70g COST means the actual or estimated dollar amount charged for the
<br /> permitttd wark including rnaterials,labor,profit,and other fixed costs. It is the amount to be eharged
<br /> to the customer for thc work done_ If any material,equipment,labor or installations zre fumished by
<br /> the owner,tenant or any othtr party,the reasonable mark�t valu�of such it�ms must be added to the
<br /> estim&ted cost or contract prict far permit fee purposes. In thB Bvent that thcrc is a dispute on ihe
<br /> amount of the job eost, the Ciry may rcquest the submission of a signecl eopy of the actual contract.
<br /> ��s; ..,..�..Y ...� �-( �y y� .
<br /> iy Sy�����»,c�L� + 3�, •: '_*'��:/•�''���,� NT �/ T�ATr �v�a[TT V.. ,�,�� 1 �,�(
<br /> .
<br /> �h!`:?�i9��`f'l�}iA��Y:•'"'�`^7''�•"MY.. ..� .�,'`« :� ,wif (l,'�"1J/` �"� .:.�i.1�,.� '�G t����''3�°�;'?�7�.SS�!
<br /> ,; _.. , ..
<br /> .. . .
<br /> .i.ln:.,.,..... ;.... ...�..:. . ..���.... .;�ts4.Q�� � � .
<br /> The undersigned hereby applies to the City for issuanee of a Mechanical Permit,agrees to do all
<br /> work in strict accoi�dance with the ordinances of the City and t�ie regulations of the State of
<br /> Minnesota, and certifi�s that all statements made on his application are complete, true and
<br /> correcl.
<br /> � �X�� Y� �
<br /> Appticant's Signature: Date:
<br /> 3
<br />
|