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2013-12-23 09:23 W1087 Pharmacy 952229b455 » 9522494616 P 3/4 <br /> � ; <br /> . � <br /> . <br /> - i <br /> i <br /> . i <br /> � �y���������� ��� <br /> � � �� .. .�7rr,t'f.:�r�+41�*��`t7�#7� t�'t,,�.��...-: , ':. ,: <br /> '�` .%}.., i . ? ,` ....'...�, . . .� `��. <br /> ❑ ' Ycs,ihis sectiun�pptics � <br /> ' � <br /> The repiacement of a�j�c�e�tial fix�rc or a.,*roHance ihat meets�11 three of the following requirem.ents; <br /> 1 <br /> 1. not require modi.fication to electrica!or gas s�cvico. <br /> 2. Has a tgtal cast of�500,44 or less;eacc�udine the of thc fixtwe or sppliance;an�Q <br /> 3. is improv�d,instatlal ar replxced!ry the hameown�r ar licrosed coatractar. <br /> i <br /> Skip next section,if this applies; Cost of P � it $ 15,t}0 <br /> State Surc�ge $ S.Qq <br /> Mait-In F (IfAppiicable) $_ 2.Q0 <br /> Totat Per��t Fee $ <br /> , <br /> ° � � :"���'i��,.��:;4+�.r(:i,�.tl��-kiF � r"` 4 �r. �,�y . . <br /> ,'-��#�:.��t�� <br /> tf above does nut apply;fntfow�uidelines belaw: } <br /> I <br /> i. CON'I'RAC'��'R[C� �is i.25%af contrsct pric�with a(Minimam�'a of 550,00) <br /> �'G •,� i <br /> x.U125$ "�� . �� <br /> (contract price) � (tniqimum SSOAD} <br /> � <br /> ' 2. STATE SIJRC�1 ,�^ 1 <br /> .�� .3 �ca�d � x.Q405 $__�___`�r� <br /> (conaacx pricc) � <br /> 3. POSTAGE&HANDL.tNfl(Only an Maii-In Applic�tions) $ _ 2.00 <br /> i <br /> � <br /> � <br /> ' 4. TOTAL.PERMTf FEE(Add Linetis:I-3 Above) f $ � ,� <br /> I <br /> • �;CO:V'TRACT PFLtG'E or J()[3 COST means the act►�al o�estixnated dollar amount chxrged for th� <br /> pe�miued work including mateciats,lahor,profrt,end other xed costs. It is the amount ta be charged <br /> to the customer for the work dane. If any msterial,equi t,lebor or installations are fw�n.ished by <br /> tbe owner,cenant or�r�y other party,tt►e reasonabie marke value of such rtems must be added to ihe <br /> estimated cost or cantract price fnr permit fee purposes. �n the event that thorc is a dispute on the <br /> �tnount af the job cost,the City�nay t�quest the sutrmessi�n of a Si$ned copy of the actual cor�tra4^t. <br /> � <br /> � <br /> � <br /> s <br /> a <br /> i <br /> � <br /> ;� ,..;:��i� ��. .�r.��i��;���+�� ..� �����,�.��.. , . '.:.: <br /> The�ndersigned hereby applies to tl�e C:ity for issuance o�'a Mechenica! Aermit,a�rees to do all <br /> work.i in str'tet accordance wi'tfa the o��linances of the Ci end the regulations of the State af <br /> Minr�sota, s�nd certifies that alt staYements made on th�s application are complete, true and <br /> corre�t. � <br /> ; � <br /> App2icanYs Signatur � ��: � c�,,,� •-��'? ' <br /> ; �._.___�.._. i'�.�' <br /> F <br /> , <br /> ; <br /> � <br /> � <br /> 3 � <br /> ; <br /> ; <br /> � <br /> � <br /> } <br /> � <br /> � <br /> i <br /> � <br /> i <br />