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Catie Peck—Long Ext691 ( 3/10) 01/30/2015 08 : 59 :41 AM —0600
<br /> _ P�I�MiT`FI E �"�LC l�LATil(3�'(S) ;" �
<br /> � ���' " � B:�SE:ll OF��� �13(3� SrAT� 5I �T"U� ,�" ,
<br /> ❑ Yes,tl�is section a�pli�s
<br /> The replacement of a Residential fixture or appliance that meeYs all three of the following requiremen�s:
<br /> L Does not require�nodi�cation to elect�ical w gas service.
<br /> 2. IIas a total cost of R500.00 or fcss;cxcludin�thc cost of thc fixturc ar appliancc:and
<br /> 3. Ts impr�ved,installed rir replaced hy the homeowner or licensed contractor.
<br /> Skip nexY section, if this applies; Cost of Permit $ 15.00
<br /> State Surcharge $ 5.00
<br /> Mail-In Fee(If Applicable) $ 2.00
<br /> 'Total Permit Fee $
<br /> � P�;R11�(;T F�� C"AI.( l:�L.Pa�"YO'N(S j-�JOBS_fJVEI�'�r50�,(�Q';;;�j���ii%�%,.,,, '..r;
<br /> lf abo��e does noY apply;follow guidelines balow:
<br /> 1. CONTR?�CT PRICE *is L25%of contract price witt�a(Minimum Fee of�50.00)
<br /> � `�f,.� ��;.t��.�� X.o12s� J<> `�; .,�.__�
<br /> .---�.._...—��---_...._....._.._._.__...
<br /> (cnnTractprice) (roinimum$50.00)
<br /> Z. STATE SURCHARG� ,/ -
<br /> .. ��,.D��,�.7(-�___..._.__...x .0005 $_C!_���._..----.___._.....
<br /> (contract pricc)
<br /> 3. POSTAGE&HANDLIN�Ci(Only on iv1ai1-Ii�Applications) $ 2.00 D�� �
<br /> ,�,-7 ,� ,
<br /> 4. "TOTAL PF,RMIT FEE(Add Lines i-3 Above) $ P��-�)� ��-�
<br /> ■ * CONTRAC'I' PRTCE or JOB COST means the actual or estimated dollar amount charged for the
<br /> �erinitted work including i�iateri�als, lal�or,profit, and other fixcd eosts. It is the amount to be charged
<br /> to the customer for the�vork done. If any material, ec�uipment, labor or installations are furnished by
<br /> the owner,tena�at or a��y otl�er party,the reasonable market value of such items must be added t'o the
<br /> estim�ted cost or contract price for permit� fee pun�oses. In thE e��ent that there is a dispute on the
<br /> amount af thc job cost, the City may i-equest [he subTnissio�� of a signed copy of the actual contract.
<br /> � �CHt�.I�T����;;P.. R,�'�✓��T`1`',�P���`A'Z'.ZON�,�("rd���:1V1�',,�"%ii,i�,,.,;�%;;���ii� ,��ii<
<br /> , ��,���,�>
<br /> The undersigned hereby applies to the City for issuance of a Mecl�anical Pennit, agrees to do all
<br /> work in sti•ict accordance with the ordina��ces of the City and the regiilations of the State of
<br /> Mitmesota, and certities tl�at all stateinents ma�de o» this apptication are compiete, hue and
<br /> correct.
<br /> ..�
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<br /> / ......�,
<br /> / '' r� f �
<br /> Applicant's Signature: , � ,�.� ��" ,.�t'°/� � Date: � ,� .`� d `
<br /> �
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