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11-11—'15 12:17 FROM— T-424 P0009/0010 F-760
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<br /> -1" ���> '-;�� ,, ,u;8�4S��.OP��:.20Q2�STATE`;STE1'I'U� 'N.�; ,
<br /> [] Yes,this section applics �
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<br /> The rtplacem�nt of a Residentiai fixturc or annliance thAt rneets all three of the foilpwing requirementS: .
<br /> 1. oes not requirz modification to electrical or gas servicc. �
<br /> �. Has a�L�e�of$500.00 or less;e clx uding thz cost of the fxture or appliance;and
<br /> 3. Is improved,installcd or roplaced by the hameowner or licensed contractor.
<br /> Skip next section,if this applies; Cost of Permit $ L5.00 -
<br /> State Surcharge � 5.00
<br /> Mail-Tn Fee(!f Applicablc) $ 2.00
<br /> TotA��ermit�'Ce $
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<br /> si"`sr''L.''�1,1„"i1,DL",;�i��%�r. �;F�r'!�'�.�AV ,�. -;V1JLl�7'.��.(�V�!.!P��0�.00,,;'';.;''.,.,:"r,�;,.::,;.,;�;.y,,�..`��.
<br /> [f above does not apply;follow guidellnes btlow:
<br /> 1, CONTYtACT p�tYC� �is 1:?5%of contwaet price with a(Miaimum�ee of SS0.00) !
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<br /> (ConVBct pncp): (minimum SSd.00)' �
<br /> 2_ STAT�S�1YtC�AYtG� � �
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<br /> � ��--' X:000s::$ � —f
<br /> '(�O�asct priCe}
<br /> 3. POSTAGE&HANDLiNG(anly on Mail-In Applications) '$ Z.00 - `
<br /> 4. TOTAL PERMIT FEE(Add Lincs 1-3 Abo've) $: , �.�E \J �`
<br /> ■ * CONTRACT PRIC� or J0� C4ST means the actaal ar estimated dollar amount charged for the
<br /> permitted wark including materials,labor,profit,and other fixed costs, It is thc amount to be charged
<br /> to the customer for the vvork done. If any materi&1,equipment, labor or installations are fttrnished by
<br /> the owner,tanant or any othcr parry,the reasottablc markct value of such items must be added to the �
<br /> estimated cost or contract price for permit fee purposes. Cn the event that there is a dispute on the
<br /> amount of the job cost,the City may request the submission of a signed copy of the actua!cant�•act.
<br /> ;:�; ;"`: ��.1VIEC NI�A� �t1VIr1:'AP L�CA'T`IOIN:'A� � �T•,°�' :�'� :`''`;,��;�
<br /> .�.,>. �A. �;:�� �' lYT�I�C. �;::;::
<br /> The undersigned hereby applies to the City for issuance of a Meehanical Permit, agrees to da all
<br /> work in strict accordance with the ordinances of the City and the regulations of the State of i
<br /> Minnesota, and certifies that all statements made on this application are complete, true and �
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<br /> Applicant s Signature: �V��y�� �.Date; `� 1 t C
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