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' 11-10-'17 12:40 FROM- T-124 P0003/4007 F-514 <br /> ��� � � �:,�• �' <br /> 1 '� � t'.5:�:, , i:. f � <br /> ❑ Yes,this section applies <br /> 1. }�oes not re9uire modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;exeludin the eost of the Sxture or appliai�ce:and <br /> 3. Is imprbved,inst�lleQ or replaced by the homeo�vner or licensed contractor. <br /> Skip next section,if this t�pplies; Cost of Permit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(Tf Applicabic) $ 2.OU <br /> xotal�ermit�'ee � <br /> '� . ' �;+�;:� �r.:4 ...r��:`.'..? a �i � .� h <br /> Ifabove does not apply;follo�v�niicielines below: <br /> 1. CONFRACT PRICE °is 1.25%of contract priee tvith a(Minimum�ee of$50.00) <br /> 1 � x.0125$ ��� <br /> contrect fuice) (minimunl 550.00) <br /> 2. STATE SURCHARGE � �r3� �.0005 $ ���I <br /> (contract priCe) <br /> 3. P�S'�'AGE&HANDLTNG(Only on Mail-In Applications) $ Z.00 <br /> 4. TOTAY�pERMIT FEE(Add Lints 1-3 Abovc) S <br /> ��"r <br /> ■ a CONTR.P.CT PRICE or JOB COST means the actual or estimated dollar amount charged for the <br /> permitted work including materi�ls,labor,profit,and other fixed cosu. Tt is the amount to be charged <br /> to the customer for the�vork done. If any material,equipment,labor or installations are furnished b� <br /> the owner,tenant or any other�arty,the reasonable market value of such items must be added to the <br /> estimated eost or conNact piice for pea�mit fee purposes. In the event tl�at there is a dispute on tlie <br /> amount of the job cost, the City may request the submission of a signed eopy of the�ctuftl contrcict. <br /> , AxdSA��SI�"i'+�i��:+ •� .i <br /> The undersigned hereby applies to the Ciry for issuttnce of a Mechanical Permit, agrees to do all <br /> �vork in str�iet aceordance �vith the ordinances of the City and the regulations of ihe Srite of <br /> Minnesota, �nd certifieS that a11 statements made on this application are complete, true and <br /> correct. <br /> Applicanc's Signature: �,�� y y � bate: L / <br /> 3 <br />