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�-- "� �-" '�- �,�Z` �� -� �� <br /> � r r" �:_ .. : �='' a: �- "�,a., <br /> `*` ����� `�-����. ���`�E <br /> T <br /> - -�A_. _-.� �. _�. :. -- <br /> T <br /> - - <br /> , <br /> ,,� �,�_�:,� �, - ..�_ _ _� ._ .�._ _ . . _� �_Y ._�� _ <br /> ❑ Yes,this section applies <br /> The replacement af a Residential fixture or appliance that meets all three of the following requirements: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Has a totai cost of$500.00 or less;excludin�z the cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor. <br /> Skip next section,if this applies; Cost of Permit $ 15.Q0 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> _ . � - <br /> If above does not apply; follow guidelines beiow: <br /> 1. CONTRACT PRICE * is 1.25%of contract price with a(Minimum Fee of$5�) <br /> �336�° �' <br /> � �.oias � <br /> (contract price) (minimum$50.00) <br /> 2, STATE SURCHARGE �" �7/r� <br /> (, J�t X.000s � 3� <br /> (contract price) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4 TOTAL PERMIT FEE Add Lin;es 1-3 Above � ��� <br /> . � ) <br /> ■ * CONTRACT PRICE or JOB COST means the actual or estimated dollar amoutit charged for the <br /> permitted work including materials, labor, profit, and ather fixed costs. It is the amount to be charged <br /> ta the customer for the work done. If any material,equipment, labor or installations are furnished by <br /> the owner,tenant or any other party,the reasonable market value of such items must be added to the <br /> estimated cost or contract price for permit fee purposes. In the svent that there is a dispute on the <br /> amount of the job cost,the City may request the submission of a signed copy of the actual contract. <br /> �� �- <br /> The undersigned hereby applies to the CiTy for issuance of a Mechanical Permit, agrees to do all <br /> work in strict accordance with the ordinances of the Ciiy and the regulations of the State of <br /> Minnesota, and certifies that all statements made on this application are complete, true and <br /> correct. , <br /> ApplicanYs Signature: _ Date: <br /> 3 <br />