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05/69/2011 13:32 6127246656 TEAM MECHANICAL INC PAGE 03
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<br /> ❑ Yes,this seeCion applics
<br /> The replaccment of a Residenti�l fixlai•c o�-aupli�nce that meets a.11 tl�ree of the following requircments:
<br /> 1. bocs not require.modification to electxic�l or gas service.
<br /> 2. Has a total cost o;f$SOO.UO o.r less;excludinE the cost o�Fthe fxture or appliance:�nd
<br /> 3. Is improvcd, ins�iled or repl�ced by the honneowncr or licenscd contractor.
<br /> Skip ncxt section,.it'this�pplies; Cost of Pei•mit 9� 5.00
<br /> State Surchar�e $ 5,00
<br /> Mail-In Fee(If�lpplicable) $ 2,00
<br /> Total Permit Fee g
<br /> ;��s ���'°'�u�}{1��S�t�
<br /> � k � .,.�,��� ,�7n;
<br /> 4.�
<br /> l�f above does not apply;follow guidelines below: �f�� l����-��rf„����U.S��DO � Dy'��
<br /> l.. CONTRACT P�.t10E * is 1,25%ol'contract price with A(Minimum Fce o�'$50.00) CZd� ��f
<br /> S�'b � x ,0125$ � ��j,�
<br /> .-�� -,
<br /> (contract price) (m;nimum$50.00)
<br /> 2. 9TAT�SURCI3A1tGE � �)
<br /> (contr c��c) x ,0005 $ � � o�•✓ "
<br /> 3. pOST/�.GF& H/1.NDLING (Oniy on MAiI-I.n Applications) $ z p1. �/��
<br /> 4. TOTAL PF. iT + + _ . S� � �
<br /> 12M. . F��(Add Lmes 1 3 /lUove) $_ (t� l�/�
<br /> ' * CONTI�CT PItiCE or JOS COST me�.ns thc ac�ual ox estiu�ated dollar a�nount cht�rged for the
<br /> permitted worlc including materials, labar, proft, and otlier fixed costs. It is the amounl to be charged
<br /> l'o th.e customcr for the work done. If any materi�l., ec�uipmcnt, labor or installations are furnished by
<br /> tl,e ow��er, tenA.nt or �ny othc�•pariy, the reflsonable ma�-ket value of such iter,�s must be addcd to the
<br /> estimated cost or contra.ct price for pern,it fee purposes. in the event that there is a dispute on thc
<br /> amount of the job cost, chc City may request chc submission of o. signcd copy of the actual contract,
<br /> "�`�uv��;yJ�'7 V,r:`�;C r�T'U�'I:����'�",�
<br /> Tl1e undersigned hercby applies to the City :For issuancc of a Mechanlcal Permit, a.grees to do all
<br /> work in strict accorda.ncc with the ordina��ces of the Cit:y a.�ad the regulatio��s of the State of
<br /> MmnesotA, a��d certi�e.s tl�a.t all statements madc on ihis applicltion flrc complete, true a.nd
<br /> correcl:.
<br /> Applicant's Signacure: %7/Gr� `� ' � T�a.te:�
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