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Apr-11-2008 p8:5Eam From-CITY OF OROIJO +9522494616 T-449 P.003/003 F-�91
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<br /> �',�,����I� i N�p ,i�; I�I������i�if,ilf i��ilu �,I'�,I I,�q� t' ��� I,.� t � � , �^�a I f. �� �� i I i 1�r i, I i n �� i, ���
<br /> .�_.. _ ��k7 �<�raIllGlli��i�����ir�%kf�i �� �11'.�!'.l,�f�il111�����li�.��I�.l "���{j��r,Y(!� 1?�<��'���jf�fir�l:'l.�I„�
<br /> � Yes,d�is seccion applies �
<br /> 1 he r:placeraent of�Residential fixp�re or dppli.;ncc thae meets alI three of�he followir�g requirements�
<br /> �, Does noi requirE�modifica�ion to e:l�;caieal or gas serviee,
<br /> 2, ITas a tnta cost�f�500.00 or less;::xeludi�the cost of the fixture or appiianee: and
<br /> 3. Is impraved,insialled or repla�ed by the hameowner or licensed connactor.
<br /> Skip next scction,if this appli:s; Cast ofPcnniF $ 15A0
<br /> Sraez Surcharge $�
<br /> N:ail-In Fee(If Applicable) � 1.50
<br /> Total�er�it Fee S
<br /> :a ' I t N,' � ��If'"i{� i �'n, I � I l h !i' � ! ,ir
<br /> 'p��y� 1 )d��) I�I(�[I � �� ���. �,'�� i'I,� '� �'i�T��i �IfP �N`�� f � ,���' ��I4�+�i�t������E�3 ii��1����I�i��'��{
<br /> ��`�f�.l� 341��� '���t°�"I,I7� le f i. � �' t "'1i ,� I �t .zr ,i I i��1141
<br /> If abc�ve does not a�ply;faIlqw guidclines l�elow: �
<br /> 1. CON'['RACT t�RICE * is 1,z5°10 �f eontracr price«th a{Minimum Fe�:of$35.OP) � �'� \ �
<br /> -- �1��0�0 ��L -- x.0125 $—_ _...._.
<br /> {convnci price} (rnin;mum 53�,M) �
<br /> 2. STaT�SURC�FTARCE **��dd r]�e Statr,131dg Code 17iv. 5urcharge(1Vlinim��m Fee of�.50) � �
<br /> �
<br /> - � /�C�.C� � .000s $ -
<br /> (cont•ac�Pnce) (ir!inimum$ .5U)
<br /> 3. pOSTAGF&H!�NDLING(O��ly on Mail-[n Applications} $__ 1,Sp
<br /> 4. TOI'.4T��'�RNi]:T FEE(.�dd Lines 1-3 A'�ave) � ,
<br /> ■ ' �ONTIL4CT 1'1tICE �r JQB COS7' mef.ns cAe actual or estimated dollar amc�unt charged for r�ie
<br /> F�ermi�ed work includin�.=,n�t�rials, la�or, �,rofit, and other fixed costs, it is the amount to be clzarged
<br /> to the customrr£or the �aorl:done. If any anaterial, rquipmcnt, labor or inst811stion5 arc furnished by
<br /> thc owncr, zenant or any other paxty, the reasonable rn3rket v�lue of such items must be added to rhe
<br /> f sTimated cast or canna:.t price for p:rmit f�e purposes. In the event that there is a dispute an the
<br /> �mount af tlic job eos�, the Ciry may request the submission of a signed copy o�'thc acrital contract_
<br /> ■ ''"1`he STA7'E SGRCH.�RGE is.000 i af t'.ie�uilding Department at(952}249-4600 for the price.
<br /> �,�,.,�ai�r�� °,�i�i.y���j �l i � �,�,H �'�' �;,E,�"� � i���i� �';���'�Q�'1�;��' ' `'����'��ff�li:{,�III�,E'�'�,'s '��'',i.l,�l!';`�.
<br /> �i i ia.. r i I�(��.I�, � n i m inii t a
<br /> The undersigne�i l�ereby a��plies to the Ciry for issuance of a Mechanical �'ennit, a�ees to do a11
<br /> �vorl: in strict accordance With the ordinanees of the City and thc regulations of thc Statc of
<br /> Ivlirn��sota, ana certifies th�t all stat�mer►:s mac�e on Chis appl'acation are cc�mplel'e, true and
<br /> �oiT��ct.
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<br /> .�pp icant's Si�mature: ��-`�`"� __ l�aF�:�;.,2����
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