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02/16/2014 07:56 9528947972 LAKESIDE PLUMBING PAGE 04/04 <br /> ,,.. ., <br /> ;::�,::.: •: <br /> ; <br /> , <br /> ,,.� � . . �:. '�AL@� <br /> _.:,....,.. <br /> , <br /> ........ ...... . <br /> .. ��r1T1.OT�(S , <br /> � <br /> , . <br /> )� <br /> . ..:,_.. . ,,. .. .. , <br /> -.> :::. .. _ <br /> 13�1.SED..OFF��;,.�2.b0�'�9T�4;T`�.ST .''�:. ' '� � <br /> �k�'i]E';�.. � <br /> ❑ YCs,this section�pplics <br /> 'i'he replaoement of a Residcntia.l fixture or Annliance tiiat mcetc a11 three of thc following requirem,ents: <br /> 1, Does not require modificatlon to eleclrtcal or G�s service. <br /> 2. I-fAs A Cotal eost of$500.00 qr I�ss;cxclud._ in�the cost of the fixtur��r spplianc;c:a�id <br /> 3. Is irnproved.installed or rcplaced by thc homeowncr or licensecl contr�etor. <br /> Skip next section,if this a.pplics; Cos4�f p�rmit � �S�� <br /> Stgte Surcharge $ 5.00 <br /> Mail-In Fee('If APPlicablc) $ 2.00 <br /> Tc►tal,Permit f�C � " <br /> . , -.rERNrrT:��E:cAr�C <br /> Ui:;A"r[.ON:s ,,:��ri��S�a'�R <br /> _ -- (�...�.= ;�5bo:00 : ._—�� <br /> ff nbovc daes nnt apply;1'ollow guidcllncs below: <br /> 1. CONTRAC'1'�.RiCE * is 1.ZS°/n af contract price with a(Ni��►imum Fcc nf 550.00) <br /> ��l dOC3 _ x.0125$ �^�� <br /> (.�nntrlCl pticc) ^ (minimu�n$50.00) <br /> 2. STATC SiJRC.1.�kAl�GE <br /> — .— ,. x.O005 $ � <br /> (cnnlr.ict pricc) �— — . - — <br /> 3. POSTAGE Rc HANI�I,ING(Only on Mail-In Applications) g�p0 <br /> 4. TOTAI.PERMIT FEE �dd Lincs 1-3 Abovc � �� � <br /> ( ) � � <br /> • * CONT1tA.t:T PRIC� �t JOB COST mcang Chc actual or estimated dollar tuttount chargcd for the <br /> perntittcd work includin�materialR, I�bor,profit,anci oChcr fi!ced eostc. ft is tlie s�mount to be char;;ed <br /> tp thc customer for the wprk donc. lP t�t�y m8teri�l,equipment, (abor or instxllati�ns a.re furnish�d by <br /> the ownet, tenant or any oU�er pgrty,the re�sonable market value of such icems must be add�d to the <br /> c�timnted cost or eontract price for permit fee purposes. Jn thc event tl�at t.herc is a disput� or� Chc <br /> Att�o[mt of the j0I7 COSt, the City m�y requcst the submission p1'�t signecl copy o{'thc actua.l contr;ict, <br /> . . . .....: .. . . <br /> :: . :.: . ..:.. .,,: . �:A iCAL"PER <br /> �. , �r;�i�?�LX:c:4;�oN:�G� � <br /> '�RE�:NIENT �; � <br /> The undersi�ned hereby applies to the C;ty for issuance of a Mechanical Permic, agr•GEs to do a.11 <br /> work in strict acoordanoe with thc ardina.nccs of the City and tlie rcgulations of tMc Scate of <br /> Minnec�ta, and certilies tl,at all statCmentg �n�de on tl,is application are complete, truc 1�,d <br /> correct, <br /> Applicant's Signaturc: `� _ Date: p2-__� � __ / �� <br /> 3 <br />