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,. .. , r <br /> � ry��� � . . . � �17 L7 r �'{z� � f �c�'/ i : <br /> � r` <br /> 3.��,,� '� ,p*��,�'`� 3-,'�,�, �r �', >�" -� a � X � ��T♦ � v.R & <br /> ( 1 ,..3<� .Y�.� ���� .�n���,,.������i.A�x.��� <`C`$�h�a,J .F.�.�� 4 <br /> . ❑ Yes,this section applies <br /> The replacement of a Residential fixture or annliance that meets all three of the following requirements: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excludine the cost of the fi�cture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor. <br /> Skip ne�section,if this applies; Cost of Pennit $ 15.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> �,� �"�'H^ � _ - k'` ���� �'�",e+�'.w�gYf - <br /> .,.v .,d.s,. -: _ , �_ __:.- _ . _ _ <br /> __y <br /> _ F ,�, <br /> . . . �.. ..,� —g �3: <br /> ,y- F" . � .'. s-�e - .. <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$5(1.00) <br /> � x.0125$�/'� �'w <br /> (contract pnce (minimum$50.00) <br /> '�� <br /> 2. STATE SURCHARGE **Add the State Bld Code Div. Surcharge(Minimum Fee of$.50) <br /> ��l X.0�5 $ ��� s� <br /> (contract price) (minimum S .50) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ � ` � <br /> ■ " CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the <br /> permitted work including materials,labor,profit,and other fixed costs. It is the amount to be charged <br /> to the customer for the work done. If any material,equipment,labor or installations are fizmished by <br /> the owner,tenant or any other party,the reasonabie market value of such items must be added to the <br /> estimated 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 contract. <br /> • **The STATE SURCHARGE is.0005 of the Buiiding Departrnent at(952)249-4600 for the price. <br /> �� �� _ _ � �+ `�: ,�� <br /> r �� �- ,�r �;;. <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 or ' of the City and the regulations of the State of <br /> Minnesota, and ce ' at all sta ts e on this applicarion are complete, true and <br /> correct. <br /> � <br /> Applicant's Signature. _ Date: 1 � Z <br /> � ��� -�� ��� , ' . <br /> . . 3 <br />