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01-25—'16 12:15 FROM— T-598 P0005/0006 F-974
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<br /> [' Yes,this section applies
<br /> The repl�tcement of a Rcsidential fixfure or��li�nce that meets all three of the following requirements:
<br /> 1. Does not require modification to electrical or gas service.
<br /> 2. Has a total cnst of$500.�0 or Izss;excluding thc cost of thc fixture or appliance:and
<br /> 3. is improved,installcd or replaced by the homzowner or lieensed eontractor.
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<br /> Skip next section,if this applies; Cost of'Permit $ 15.00
<br /> State Sureharge $. s.oa
<br /> Mail-Tn Pee{If Applicablc) $ 2.00 �
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<br /> Total Permft�ee � `
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<br /> If above does not apply;follow guidelines below: �
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<br /> 1. CON''�XiACT�XtXC� *is 1.�5°/a of contract price with a(Minimum Fee of$50.00) �
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<br /> x.oizs$ `
<br /> �c4ntract.pr!CC) (minimam$30.�w
<br /> 2, STAT�$rJYtGHARCE � I
<br /> • ��d X.000s $ �. �6
<br /> COn1raCC piiCz) i
<br /> 3. POSTAGG&HANDLING(Only on Mail-In Applications) $ �69' '
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<br /> 4. TOTAL PERMiT FEE(Add Lines 1-3 Above) $ : . .:(J. �.:: � .' � `.
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<br /> • * CONTRACT PRICE or ,�0� GQST means the ackual or estimated dollar amount ch�rgod for the �
<br /> permitted work including materials, labor,profit,and oCher fixed costs. it is tht amount to be charged I
<br /> to the customer for the work done. 1f any imaterial,equipment,labor or installations are furnished by �
<br /> the owner,tenant or any other party,the reasonable market value af such items must be added to the `
<br /> estimated cost or contract price for permit fee purposes. In Che event that there is a disputt on the
<br /> amount of the jab cost,the City may request the submission of a signed copy of the actual eontracC. ;
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<br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit,agrees to do all
<br /> r�vork in strict accordance with the ordinances of the City and the regulations of ihe State of
<br /> Minnesota, and pertifies that all statements made on this appiication are complete, true and
<br /> corraCt.
<br /> Applicant's Signature: j��'�'v �+'�����"� Date: � .
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