Laserfiche WebLink
' ' �04-17—'15 09:36 FRO�— T-739 P0043/0043 F-905 <br /> , <br /> ; <br /> � <br /> �' A 1 <br /> �. <br /> ,;(� ?' {i <br /> ! <br /> ❑ 'Yes,this section applies ? <br /> � <br /> t <br /> Thz replacemant of e Residential fixture or appliance that meets all three of the following requirements: <br /> l. Docs not require modification to eleotrical or gas servicc_ <br /> 2. �Tas a�total cost of$500.00 or less;exeluding the eost of the fixture or appliance:and { <br /> 3. Ts im�roved,installed or replaced by the homeowner or licensed contractor. , <br /> Skip next section,if this applies; Cost of permit � 15.00 <br /> State Surcharge $ 5.00 , <br /> Mail-In�ee(Tf Applicable) S 2.00 <br /> Total permft�'ee $ � <br /> �' Y' � � v £ 11 � ';�: <br /> Cf abo�ve does not appl�;follow guidelines below, <br /> 1. CO1V„�RACC'pCtYC� *is 1.25%�f contract price with a(Minimum�eo of SS0.00) <br /> �'1"'"�-� x,0125$ <br /> �\�� (eontract A��ca) (mio�mum 540.00) <br /> 2. STA�'E SURCHARG� � <br /> �.x.00�5 $ 1 . 5 <br /> (Con act price) <br /> 3. POSTAiCrE 8c ITAND�,ING(Only on Mai[-Tn Applications) $ 2.00 <br /> 4. TOTAL pERMYT�E�(Add Lines 1-3 Above) $ �/C� "�� � <br /> ; <br /> • * CONT1tACT'p1tYC� or JOB COST means the actual or estimated doliar amount charged for the ; <br /> permitttd work including materials,labor,profit,and other fixed costs. Tt is the amount to be charged ; <br /> ro the custome�for the work done. Cf any material,equipment, labor or installations are furnished by � <br /> the owner,tznant or any other party,the reasonable market value of such items must be added to the <br /> estimated cost�or contract price for permit fze purposzs. Tn the event that there is a dispute on the <br /> amount of thz job cost,the Ciry may ra uest the submission of si�ned copy of the actual contract. E <br /> �1C, �p Gl n Q� �I� �S(� l¢34� 44�� q�l��� � <br /> 0 ` <br /> �� <br /> �! 7.� 5 . � � �`1�1 9 <br /> �-�y�1',:�p'.P✓4-.,-.y N��,�.i. "���fyR� - . . . :,1e..1.v_.,e ,{�h.:�:.\�.y'.., � <br /> I't7i�'�:�4'�lv�r:"S1�:Sil� J- �� R.. 'r 5 �ti .f' .:P;� .����.��yV.,n.., -��.,��� ` <br /> l� �.\!��'':�h:l'X/��':�',��'f <br /> � <br /> The und�rsigned hereby applies to the City for issuance of a Mechanical Permit,agrees to do all a <br /> work in strict accordance with the ordinances of'the City and fhe ��egulations of the State of i <br /> Minnesota, and c�rtifes tNlat all statemonts made on this application are complete, true and <br /> carrect. <br /> A licant's Si nature: Date: � U�� �, <br /> PP g <br /> 3 <br /> I <br /> � <br />