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� From�,je;�.sinke Far.:(612)444-3627 To: Faz: +1 (952��494616 Page 5 of 5 06l01 J2016 7:12 AM <br /> _ . . P�r�r��E c�,cu�;�������;. ,,.. . <br /> , : ., <br /> , <br /> . : , '. BA`S�.QF� ��Qz S'I'AT�,�`��T� .: �.: <br /> ❑ Yes,this sectioo applies <br /> The raplacement of a Residential fix re or a liance that meets ail three of the foliowing requirements: <br /> 1, Does not reqnire modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excludine the cost of the fixtw•e or appliance; and <br /> 3, Is unproved,installed or replaced by the homeowner or licensed conn•actor. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ S,QQ <br /> Mail-In Fee(Tf Applicable) $ 2,pp <br /> Total Permit Fee $ <br /> . pF,�zT FE���t;cuz�'�'�o� =3�0��� o ' r���soo:�ao .; ': , <br /> Tf above doas not apply;follow guidelines below; <br /> 1, CQNTRr�.CT PRICE *is 1.25%of contract price witl�a(Minimum Fee ot'$50.00) <br /> ���f� � <br /> _ '.�'`'�-�-•-- x,a 125$ <br /> (conYract ptice) (minlmum$50.00) <br /> 2. STAT�SUItCHr+�RGE <br /> x,0005 $ <br /> (contract price) <br /> 3. POSTAG�&I-TANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT F�E(Add Lines l-3 Above) $ � �-�� <br /> ■ * CON7"RACT PRIC� ar JpB COST means the actual or estimated dollar amount charged for the <br /> permitted work including materials, labor,pro�it, and other fixed costs. It is the amount to be charged <br /> to the customer for the work doue. If any material, eguipment, labor or installations are fiuvished by <br /> the owner, tenant or any other party, the reasonable market value of such items rnust be added to the <br /> estunated cost or contract price for permit fee purposes, In the event 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 conb•act, <br /> �Iv.�ECHANI�AL P��IT,APP�IG -'��t��1�A ���N`I' � �;� <br /> The undersigned hereby appiies to the City for issuance of a Meclaanical Pennit, agrees to do aIl <br /> work in st�-ict accordance with tl�e ordinances of the City and the regulations of tha State of <br /> Minnesota, and certifies that all statements made an this applicatian are complete, true and <br /> correct, <br /> � � <br /> Applicant's Sig-��ature: ��v R� Da��; �''l'f�p <br /> 3 <br />