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from:B&D PLUMBING 7634974263 11/19/2013 16:57 #076 P.004/007 <br /> , <br /> ❑ Yes,this section applies <br /> The replacement of a Residmtial or a,ppliance that raats aU three of U�e followibg m�uirementa: <br /> 1. �oex�ot require modification to ela�'ucal or gas service. <br /> 2. Has a total cost of SS00.00 or less;e lxc udina the cost of the 5rcture or applim�ce:aad <br /> 3. Is improved,installed or replaced by We homeowner or licen�d contractor. <br /> Skip next section,if this applies; Cost of Pennit S 15.00 � <br /> State Surchargo $ 5.00 <br /> Mail-In Fee(If,Applicable) $� <br /> Total Permit Fee S <br /> If above dcee not apply;foAow guidelines below: <br /> 1. CONTRAC'T PI�IG� '"is 1.25"/0 of contraM price wid�a(Misimaut Fce o!SS0.00) <br /> lY. ��(�� x.0125 S � �,�.�� <br /> ��!—�`l'�onaact psice) (mirima�S30.o� <br /> 2. 5TA1E SUBCHARGE l �" r i <br /> � I O� �� x.0005 $ lfd,� t� ` <br /> �(c�aaa p�) � <br /> 3. POSTAGE&HANDLING(Only on Mail Ia Applicaiiona) S 2.00 � <br /> E <br /> f <br /> 4. TOTAL PERMIT FEE(Add L'u�es 1-3 Above) S � �.Q�,� l� i <br /> • * CONTRACT PRICE or 70B COST means the actuai or estimated dollar amwmt charged for the <br /> peimitted woik including materials,labor,prof�and other fixe�costs. It is the amouat to be chargod <br /> to the custoraer for the work done. If anY material,equipmeat,labar o�iastallatio�s are fiuniahod 6y <br /> the owner,tenaat ar any other puty,the reasoaable market value of such item�t�sst be added to the ; <br /> estimated coet or coatract price for permit fee piupose.s. In Uu event that thve ie a dispute on the <br /> amouat of the job cosk the Ciry may request the s�bmission of a signed copy of the actusl contract. <br /> Tlic uude:rsigurd hcrcby applies to die City for issu�ce of a Mcxhauical Pc.znait,agrtxs to do all <br /> work in strict accorda�ce with the ordinanccs of thc City and the regulations of the Statt of <br /> Minaesota, and certifies thai all statements made on this appIication are complete, �ue and <br /> cotrect. <br /> ApplicanYs Signature: �ate: !�/ / / � <br /> 3 <br />