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07/14/2017 11:51 7635354379 GOLDEN VALLEY HTG PAGE 02/04
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<br /> ❑ 'Yes,xhis section app�es
<br /> The replaceme�,t of a R �dentia �xture o�p lP�iancc thac�nn�cts a�a�hree o�ctae Foilowing rec�uiremer�ts;
<br /> ]• Does not require mod�fication to cicc�rical or gas sezvice.
<br /> 2. Has a t [cost of$500_00 or�ess;cxc u in tb,e cost of the�'ixture or app�ance:a�d
<br /> 3: Is axnproved,installed or rep�accd by ihe hozn�eowner ox licensed contractor.
<br /> Skxp ncxt section,if chis ap�]ies; Cost of Pemuit $�5,�
<br /> State Suzcharge $� 1.00
<br /> Mail-In Fee(�fAp�licab�e) $ 2.00
<br /> Totak Pernouit Fee $
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<br /> �above does not apply;follow guidelin,es below:
<br /> �• C�� T p � �is �.259�o af con�act pricc with a(Mlninoum Fee of�50.00)
<br /> Ox.0125$ � ��
<br /> (contracc price) (miuimum S O.Op)
<br /> 2. �TA, TE SU' C� �J C,(`�
<br /> x.0005 $ ��
<br /> (cronuea price)
<br /> 3. POS�',A,G�&HA�IDLING(Only om Mail-Zn,A.pplica�ious) $ 2.00
<br /> 4. TOT,A.L�ERN�T FEE(Add Lz�es 1-3 Abave) $ ��� �
<br /> ' � CONTRACT ��CL or JOB COS'I' means thc actuaa or estimated dollar a�onount c��rged for the
<br /> pexxnitted wvck including materials, labor,profit,az7;d other�ix�costs. It is the ar�ount to be charged
<br /> to tk�e oustorrxe;r�or the woxk doz�e_ xf any r�aaterial, equipmen� laboX or install&tions axe fumished by
<br /> the owqer, tenai►t or ac�y othor pazty,the reasonable zniarket valae of suah items must be added to the
<br /> esti�c►atod cost or contxace price for pcnmit fee purposes. In the evcnt that theze is a dispute on the
<br /> amount of tt,e job cost, tb�c City may rec�uest the sub�ission o;F a signed copy of the actual contraet.
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<br /> The u�dersigned hereby appiies to the City for issuauce of a Mecha�i,caa Pemaxt, �grees to do all
<br /> r�vark ;ua striet accorda�ee with t]ae ordiwauces of t�e City and the xegulatior�s of the State of
<br /> Mi»z�esota, azxd cexhi�ies that a11 statements x�aade on Lt�is appliea�io:� are co�mplete, true and
<br /> Col7ect.
<br /> Applicant's Signatuce; Date•
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