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JUL-27-2010 01:11P FRDM:STATEWIDE GAS SERUIC 9524674605 T0:2494616 P.3 <br /> P�RMTT FCF CAI�C[JI.ATIOI�t(S) <br /> I�ASED UFF - ?l)02 STATE ST�T��L <br /> � Yes.this secl.ion applies <br /> The rcpl;�ccmcnl of a Re�lenlia3 fixt�irc or annliance Q�at ineets all tl��c oi'lhe following rcqui�ments: <br /> l. 4oes not�quirc modiGcalion to eleclrieal or gas servica. <br /> Z. Has a t4 I cas�of�SOO.W or less; I in th�cosl of the i'ixtu�e or appii�nce:and <br /> 3. Is unproved,installed or�pl�cc;d by the homeowner or licensed c�nt�ctor. <br /> Skip next section,if lhis applies; Cosl of Pennii � LS•00 <br /> SIaCe Su�cl�argE S S.UO <br /> Mait-Jn Fee(if Applicable) � 2.00 <br /> Total Pcrmit Fee $ <br /> PFR]1�1T FFr CA�,CY.f[.,AT'Tt�N(S � .II�F�S (}VER $SOO Afi <br /> If above does not apply;foUow guidelines below: <br /> 1. CONTRACT PRIC� �is 1.25%of contract price wilh a(Mtaimum Fee of SSO.AO) <br /> � <br /> � , X.ol2s� If�. Qb <br /> ( n�rsct prica) (minimum$50,00) <br /> 2, STATE SURCHARGE **Addtlie State Bldg Codc Div. Surchacge(NUntrnum Fee oISS.00) <br /> � � o� `e� <br /> x.0005 $ 7, <br /> ( troc�pricc) (minimum$5.00) <br /> 3. POSTAGE&HANDLING(Oiily ai Mail-in Applicalions) $ -�:AA+ <br /> 4. TOTAL PERMIT FEE(Add Lin�es !-3 Above) $ ���, �b <br /> • • CONTRACT PRTCE or JOB COST means lhe acluxl or estimated dollsu anwunt charged for tlie <br /> pemtitted work including mt�terials,labor,profit,aiul other fixed cosls. It is tl�amount to be chnrged <br /> to the cuslomer for lhe work do»e. If any material, equipment,labor or insttill�iions are fucaished by <br /> tlu owner,tenent or any odur porty,the rcasonable maiicet valuc of such itcros must bc added ta Q�c <br /> estimated cost or contract price for permil fc� purposes. In the event tl�at lherc is a dispul;e on the <br /> amount of tl�e job cosl, lhe City mt►y request the submission of a signed copy of the actual contn�ct. <br /> • +}The STATE SURCFiARCE is.0005 times thc Contract Price or n minimum ofi$5.00. <br /> 1�/IF.CHAIVIf:AL AFRMIT APPLICATiON ACiRRFMTNT <br /> 7he undersigned hereby applies to the City for issuance of a Mechanical Pecmit, agr.eea to do a!I <br /> work in strict accordance with the ordinances of the City and the r�egulations of the State of <br /> Minnesota, and certi.fies that all statement� made oa this application are complete, true and <br /> correct. <br /> Applicant's Signature: � f'�--� Date: ��a7�"/v <br /> � � �� ��'� 3 <br /> ..:. <br />