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��, - �- - <br /> �� <br /> ❑ Yes,this section applies <br /> The replace�nt of a Residerntial 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 total oost of�500.00 or less; xcl ' the cost of the fixture or applia�e:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor. <br /> Skip��section,if this applies; Cost of Permit $ 15.00 <br /> State Su�harge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee S <br /> If above dces�t apply;follow gvidelines below: <br /> 1. CONTRACT PRICE *is 1.25%of conkract price with a(Minimnm Fee of�.50.00) <br /> Z�Q�_UD x.0125$ ��. �v <br /> (conh�act price) �minimom S5o.o0) <br /> 2. STATE SURCHARGE �,/ <br /> ��C9�_O�0 x.0005 $ (�. (i� <br /> (cantract price) <br /> 3. POSTAGE 8t HANDLING(Only on Mail-In Applications) � 2.00 <br /> 4. TOTAL PERMIT FEE(Add Li�s i-3 Above) S �, yo <br /> ■ * CONTRACT PRICE or JOB COST �ans the actual or estimated dollar a�unt charg�ed for the <br /> permitted work including materials,labor,profit,and ot�r f�ed�sts. It is the amou�t to be charged <br /> to tl�e customer for tbe work done. If azry material, equipment, labor or installations are fumished by <br /> the owner,ten�ant or any otl�er pariy, tlye reasonable market vatue of such items must be added to the <br /> estimated cost or oo�act price for permit fee purposes. In the eve�tbat there is a dispute on the <br /> amount of the job cost, the City may request the submission of a signed copy of tt� actual contract. <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit,agrees to do all <br /> work in strict acconiance with the ordinances of the City and the regulabions of the State of <br /> Minnesota, and certifies �at all statements made on this application are complete, true and <br /> correct. <br /> Applicant's Signature: �� Date: r� � 2-2���l <br /> a�•��,�� �vz �:-�-�:x �i� . �. ; <br /> ,i �``V� � <br /> 3 <br />