|
. , .Nov. 4. 2015 11 : 11AM No. 5271 P. 4
<br /> - ;�:°, - ,::;.:;,,:.::.:: _ _ -
<br /> ,: ,,_::.::,;::;,�<-
<br /> :F � ��:�;• o ��,
<br /> �� � ,.r.
<br /> ��;�. �`.��.,. .��
<br /> .( ,,: _
<br /> �.. .,
<br /> �;�'� ,.1 �^ ...1.'a'.+1.:��,;�)'tiii'.��..
<br /> �'i::
<br /> `5�;:::�
<br /> ,.�i< '<i��..:, f:�;.�?:`.:;�(
<br /> "':1' r,`x',"1 ;a:: .�.Y.`j"..
<br /> ::4( �. '
<br /> •::��'.;';�.
<br /> ~`P',' ,`vr.
<br /> -tie;4.. ,,y��
<br /> �a>
<br /> ,::
<br /> .1 �::...,�.
<br /> .. ;v.�
<br /> .-... ,...:. ..•
<br /> ':,'; _
<br /> .,.. -..,�:y..,;.he+;.
<br /> :;,, ;;,,
<br /> •�:
<br /> 'i,r":. — •�. :l= •.Y.cr
<br /> �.i.,':n '..�.. ,�.. ,.�';."
<br /> ;`�,•; �:�'t*�(:., �:.,.^.
<br /> .�. ,:
<br /> ,._:;
<br /> �:�,,• '�'",�� �.�""'�;�� �A:g; �',ei
<br /> ,;,....,>..:,�.�.,-,. ,,..,,;
<br /> ,
<br /> ,
<br /> . .: . .. . � , .. ., A� .�1 �:.::.. ..Qq � .�t.
<br /> ❑ 1 e$a this section applies
<br /> The replacement of a that me�ets all tluec of the following requiremants:
<br /> 1. p,�eg,�require modifioation to electrical or gas service.
<br /> 2. T�as a totsl cost of$SQ0.00 or less;excludina the cost of the fixture or appliance:and
<br /> 3. Te improved,installed or replaced by the homeowner or licensed contractor.
<br /> S�ip next section,if this applies; Cost of Permit $ 15.00
<br /> State Surcharge $5 44
<br /> Mail-in Fee(If Applicable) $ 2.00
<br /> Total permlt Fee $
<br /> ':� —,:%ri=.�.,,'^� — . , a,, ,, r,�,,.,: »�. �r' ���;y��'�; ",.�"'
<br /> ,!�' O �L:" ��• , i�•q:' .,u,.,�
<br /> •' „�y.'
<br /> .• • N
<br /> ,,:::t..,;5:.... :, .. �y'��. �..y:.l:
<br /> .'
<br /> ...
<br /> ....�....o:....:;.<..,,,�:,;�c�;.,.::� ' - �a �� 'ia .�5.�.;=:c
<br /> .
<br /> , ,z . .... ��. .
<br /> . ,
<br /> .:• -,. F
<br /> ,. , . . .
<br /> .
<br /> ,, .., . . ... � ,�.:.s• _ . .._:.. _ _ 1';',�.
<br /> If above does not apply;follow guidclinas bclow:
<br /> 1. CONTRACT PRICE *is 1.25%of contract prict with a(1Vlinimum�'ee of$50.00)
<br /> � .��� ��1.� x.0125$ �L �.J�)
<br /> (contract pHco) (minlmnm�S0.0o)
<br /> 2. STATE 5URCHARGE . (� '''
<br /> �W x.0005 $ ���
<br /> (comract price)
<br /> 3. POSTAGE 8t HANDLING(Only on Mail-Tn Applications) $ 2.00
<br /> 4� 1'O'�A�,PEIiMIT FEE(Add Lines 1-3 Above) S ��• ��
<br /> ■ '" CONTRA.CT PRICE or JOB CQST means the actua! or estimatcd dollar amount chargcd for the
<br /> permitted work including materials,labor,profit,and other fixed costs. Tt is tho amount Go be charged
<br /> to the customer for the work done. If any material,aquipment,labor or installatians are fumished b�
<br /> the owner,tenant or any other party,the reasonable market value of such items must bo addcd to thc
<br /> estimated eoet or eontraet price for permit fee purposes_ In the event that there is a disputc on tht
<br /> amount of the job coat,the Ctity may request the submission af a signed copy of tho actual contract,
<br /> ... . -
<br /> . :..:::..:....;,...
<br /> . .:�
<br /> �.:. .. .. . . . . ..:.:�
<br /> ..:, � C�TAIVI.CA�'�ERiVX1`�'Ap�����'I'XON'`�4(�. -.���;':_'=''�:>�:�.::.�:,:' .�;
<br /> The undersigned h�rcb��pplies to Che City for issuance of a Mechanical Permit, agrees ta do all
<br /> work in strict accordance with the ordinances of the City and the ragulafions of the StaCe of
<br /> Miiu►esota, and certi�ics that 1 SfaCeraents made on this applieation are cornplete, true and
<br /> correct.
<br /> �
<br /> �
<br /> Applicant's 5 ature: Date�
<br /> 3 �
<br />
|