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} • Dac-04=2�012 12:43pm From-CITY OF ORONO +9522494616 T-805 P.001/001 F-403 <br /> � <br /> �r� �k� �.��9. •.��s�,kii' �+s��=r,'y,,�, <br /> �~, : � �d=• � `' 'g , '�^,. , . `"""u ��j,"� <br /> '� j'� h � �, �` � �� ��+��� ��{I� ]�i J" <br /> 1�51. :�_�t �, '���� ,����'���� arr^ r�� Q�` A ..t� iA.WI��., �. ..i5�:�°.n�: <br /> "� TM ! 2� ��xQ' ra... .�, y�,.F�., <br /> .�:,��.��.�"�,�'���,��� �:x '��.�'��.�i�S 1� � +�; <br /> ❑ Yes, [his seCtion applies <br /> The rcplacerrient of a Residcnciai fixn�re or a lian e chat aieets all tluce of ihe following reQuiremen�s: <br /> 1. oes no�reqnire mudiflcarian to elecnical or gas service. <br /> 2, Has 3 t�tai casc of$�00.00 or lcss;excl din thc cost of the 3ixnue or appIi�nce: and <br /> 3_ Is improved,iclstalled ot replaced by the hom�otvner or licensed cantract�r. <br /> Skip next sec�iun,if ihis applies; Cost of Permit $ t S.�Q <br /> S�atc Surcharge � ��� <br /> '` Mail-In Fee(If Applicable} $_ 1.50 <br /> Total Permit�ee � <br /> ,���^•,•_j �R # d'���fµr�Ju '� � Y4' I�4�1� '�iic�o�..�W'.1:.��t%��l+tir".�'a. tly�.`d..A��'� z' .t`.. �f��'�t <br /> �'b <br /> lf above does not apply; follow guidclines bzlaw: <br /> 1. CONTR�CT PRiCE ' is 1.2�:'0 ot cuntractprlcc Wi�lt�(1�iinirnum Foo of S3S_OI1) <br /> �jZ �o. �� x.0125$ _ <br /> (contrac�pricd} (n.inimum 335.00) <br /> 2. S'1 AT�: StrR(:HARG�, *"'Ada the State Bldg Code➢iv_Surchsrge(N(i�ilmnm Fee of 5S0) <br /> x.OQOS $ <br /> (contr�ct pricc) (cninimum 3 .50) <br /> 3. POSTAGE�H?+NDLING(Only on 1�Isi1-In Applicarions) $^.._ i•�� <br /> 4. TOTAL PE1tMIT��E(Add�,in�s 1-3 Above) $ _ <br /> • * CONTRACT PF10E or JOB CQST n�ans the actual or estimated dollsr am��unt chargcd fur nc� <br /> peimi�ted work includins materials,tabor,proTit,and othet ii�.ed cosu. rt is the anwunt to be charged <br /> to [he customer for che work done. If any•material,eauipmenc, labor or inscallatlnns are furnished by <br /> che owner, tcnanc or any other parcy, the reasonable market value of such items must bc added to che <br /> cstimated cost or conuact price for permi� fee puzposes. Tn the event that there is a dispute on che <br /> amount of che job cost, the City may request the submassion of a signed capy nF the actual concract. <br /> • *'"The STAT�.SU1:CH�RGE.is.00US of ihe Building Department at(95Z)244-•ti(iO4 for thc price. <br /> ��,�,_ �. ,f <br /> `�� �G+'�r". �e tr��I. �����+�� ` 'FY�;'��TJ� �� ��'�`� '�l�y+;lM�: 1. ,��'ai`t�`e��e''c�,'�? <br /> � <br /> T`he undersigned hertby applies to the City for issuanee of a Mcchanical Permit, a��ees io do all <br /> Work in strict accordance with the ordinances of the City and the regulations of the Scate of <br /> Minnesota, and certifies that all stati;ments rnade on this application are complete, true and <br /> correct. <br /> . �� 2� � �� <br /> Applicant's Signature: < Date: <br /> 3 <br />