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01-25-'16 12:15 FROM- T-598 P4003/0006 F-974
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<br /> ❑ Yes,this section applics
<br /> The replacemen4 of a Rg��dgntial fixture or appliance that meets all three of Ehe follor�ving rzyuiraments:
<br /> 1. Does not require modification to eloctrical or gas service.
<br /> 2. Has a total eost of$500.00 or Iess;excludin the cost of the�ixture or applianee:and �
<br /> 3. is improved,installzd or replaccd by the homeowner or lioensed contractor. ,
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<br /> Skip nt�ct stction,if this applios; Cost af Permit $ 15.00
<br /> State Surcharge $ 5.00
<br /> Mail-In F�(If Applicable) $,�,., z.�0 ;
<br /> Tofal Permit�ee $ �
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<br /> !f above dozs not app{y;follow guidelines below: E
<br /> 1. COIVTRACT PRICE * is 1.25%of eontract pric�with a(Mfnimum Fee of 550.00) �
<br /> � � •X�.0125$:,. : ��(J��..;....
<br /> �(�pn�r�pricc) (minlmum�50.�)
<br /> z. STAT�S�1YiC�AYiG� .�w� ,
<br /> X-:���5.:$. � ;
<br /> (ContrOCt prict) ;
<br /> 3. POSTACy�&HANDLING(Only an Mail-in Applications) $ �� �
<br /> 4. TOTAY,P�TtMTT���(Add Lines 1-3 Abovt) S .: •�17.� i
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<br /> � ■ * CONTI2ACT PRICE or JOB COST rnzans the actual or estima4cd dollar amount oharged for the F
<br /> permitted work including materials,labor,profit,and other fxed costs, it is the amount to be charged j
<br /> to the customer for the work done, If any materia3,equipmcnt, Iabor or installations are furnished by `
<br /> the owner,tenant ar any othcr part�,the reasonable market value of such items must be added to thc F
<br /> estimatcd cost or contract price for permit fee purposcs. Tn tho cvent that thcrc is a dispuCe on the
<br /> amount of the job cost,the City may request thc submission of a signed copy of the actual contract.
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<br /> The undersigned hereby applies to the City foi•issuance af a Mechanic&1 Permit,agrees to do all
<br /> wo►•k in strict accordance with the ordinances of thC Giry and the regulations of t�►e State of
<br /> Minnesota, and certifios that all statements made on this application are complete, true and
<br /> coiz�ect.
<br /> ' Applicant's Signature: �-��'�'V �'v�'WG�'L�'1^ pa�c: ��-7
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