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05/02i2011 12:11 DITTER INC � 9522494616 N0.436 D03 <br /> C �"'.li' of r{.l: : ' t . h:. � i•hn � : rt�k . <br /> ;,. �l.i' �i� ':i.�.1: •� • '•. ...'. •', . ',1�:.. . �:i <br /> n yy�F �d/ 1. �� <br /> � . . . .•��,�„1 •�I`�8'��' Y ������� �� <br /> ❑ Yea,this section applies <br /> 'C'he replace�ment of a Residsntial_f�reior a,p�lian�th�t meets ali tht+es of the following roquir�tments: <br /> 1. Does no require modification to electrical or��s sorvice. <br /> Z. Haq a to c�of$500.00 0�less;e�rsl in the c�t of the fi�re or applience:and <br /> 3. fs improved,installed or ceplt+ced by the homeowne�c or licensed wnlractor. <br /> Skip next sectio�,if this epplies; Cost ofPermit $ 15-00 <br /> State 5urcharge �_ S•� <br /> Mail-Yn Pee(if Applicable) $ 2.QQ <br /> Totnl eera�it Fee S <br /> .. ,� �'��� �£����� ,�T�. �; � $�00. � <br /> If above does not epply;foltowv guidelines 6olow: <br /> 1. CO�TRACT PRICE "`is 1.2596 of contrsct prisx with a(Min9mam Fee o�$50.00) � <br /> a7Y� x.o,zss_ . <br /> (conawcc prico) (aa�otaium s9o.00) <br /> 2. �{'A�ARG� ���� <br /> x.Q005 $ �' � <br /> (conQacc prico) <br /> 3. 1�OSTAGE&�ANDLTNG{OWy cn Mail-In Applica�ions) S z.� <br /> af�� ? <br /> A. TOTAI.P�RM1T FLE(Add�in�s l-3 Above) S <br /> ■ y CONfRACT P�CE or IOB COST rneans che sc�usl or estimated dollar amount ch�gal for the <br /> pe,mimd work including meteriafs,taboz,profrt.and other fixed cosrs. rt ie the amount to be cAarged <br /> to tho customer for the wrork done. If eny meterial,�q,uipment,labor or iastaila�ions are t'umished by <br /> the ovmer,tenant ar aay oiheT party, �he r�asonablo market valuo of such items must be added to the <br /> esmnaioed cost or eontract prias for permit fee pur�wses. [n tbe event that rhera is a dispvice o� the <br /> pmount of the job cost,the City mfly request tl�e submission of a signed capy of the acw�l conbaet. <br /> . �. % � :� .; <br /> The undersigned hec+eby applies to the City for issuanoe of a Mechanicat Permit,agrees to do all <br /> work in strict accordance with the or+�inences of the City and the r�gulations of the State of <br /> M�ota, and ceTtif�es that all stat�ments made on this application are complete., true and <br /> c.�mec:t. <br /> Applicant's Sig�aturc_ b�: ~"Z' '�� lr <br /> . �• - �' ••�G.i ,�, <br /> � , ���� � <br /> 3 <br />