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dul-D3-Y002 i2:5Qpm Fram-CITY QF ORONO +9822484616 T-5BD P.Q02/OQ2 F-T8�
<br /> PEI�.MIT �E CAZ.��,1L,�''YQN,� .
<br /> �_�ta#e �tah�t� �Y�s, Tl�is S�t�on Applies
<br /> 'Tk�� roplacem�ent of a aiden;,r,ial fix ��nr�l�r� t�at meet� alI tluee o�' the fallowing
<br /> requir�mex�[s;
<br /> 1) Does noc reqttire rnodi�catio�, to�lectrirat or ga�s servic�.
<br /> 2) Has a o 1 at o�'$�OO.OQ �r Iesa; �,�„'�the co� af the �'�e or appziance:
<br /> and
<br /> 3) Is improved, installe�d �i�replaced by th� homsaa+ner or licenc�d contx�ctor.
<br /> S.l:i� next section; Co�t of permit � --. 1��.,
<br /> State Surc�.rge $ — _,p�.._
<br /> Iv�ail �n Fee �
<br /> � ---.—�.�—,�
<br /> If abov� dc�s nat apply, follow �uidelines iaelaw:
<br /> 1. �ontra.ct Fri�e� is .QX25 % o�job with � '� ' � Y+'ee gif rS35T4a�
<br /> �, x .Q12S $
<br /> (contr;�ct priGs} (minimttm,$3S.QOa
<br /> Z. �t� Surcha� �� Add the State Huildin,� Gcxl� L'�ivisian a (1V,�'inimu� Fee ot$ .54)
<br /> ,.� x .OQ45 $
<br /> (contract price) (miniFnum� .50)
<br /> 3. pasta�e anc� Har�� (C,�r�1y rnail-�x� applications) $ S'�„0_,
<br /> �
<br /> 4. ',�'OTA�PERM�T�'EE {Add Ii�es 1-3 above) $ ���(1, .,,.._
<br /> * C(3NTl�.ACT PR.IC�or JC1B GQST means t�e actuel er es:imateQ dQllar amo.,u�t charg��for th�p�rrnitted
<br /> wor�C i.qcludin�zn�,te�rzals,labor,prafi�,anci other�ixed costs, IG is the amou�t to be cbar,�ed w t�ie customer
<br /> �Eor the work do�e. IP anp rnateri�l, equipraent, labor, or instaltation ax�furnisbed by the awner, cenant�rr
<br /> any other p�ciy the reasoria�l�markee rr��ue of such iu�ma must bc added co the esdatat�d cosi or cottuact
<br /> prico for perrnit fee�u�oses. Ia clt�+�vent th�t c�ere is a d'zspute on the az�aunt of chc aob cos�,rhe Ciry rxtay
<br /> requesL ihe subm,ission of a sigs�ed copy of th� actual cQnuac�
<br /> '"'" 'rt►s STA'TE 3URCFIA�2GB is ,00�5 of t1�e cQn�acz price uczder$1,{)Qp,000 or $,SQ-whiphever ia grea,t�r,
<br /> �ar valuations over$1,OOO,qQO cail the T�partm�nt o�Ir�spectioa Servlces for th�prics.
<br /> The undersigr�eKi hereby a,��►�ies Go the City for issuar�c� of a Flumbing Permi�, �gree� t�, dp alI
<br /> wortc in s�rict �ccordance with th� �rdinance� of tt�e City and the �egulatioz�s of �,� State r�f
<br /> Minzxesota, and �erti�es �at all sta�e�ents m�@e pm tIus appl�cati4n are camglete, t,nnte �ud
<br /> carrect.
<br /> -, ,
<br /> t
<br /> Applicant's Si�ta�.tre: r ���. ,�(i�✓C-%G�- Llate;
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