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12�17—'14 12:43 FROM— T-289 P0003/0444 F-421 <br /> i <br /> �a ' <br /> �] Yrs,this seckion applies <br /> Thc rcplacement of a Residential fixturc or annliance that meets alt three of the following requiremvnts: <br /> 1. Does not require modifieation eo eloctricat or gas sarviee. � <br /> 2. Has a total eost of$500.00 or less;exeludin the cost of thz fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner ar licensed contractor. <br /> Skip next section,if this applics; Cost of Pzrmit $ 1�.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fce(If Applic$ble) $ 2.DU <br /> 7'otal 1'ermit Fee s <br /> �i:Adi".�.�Y.. x. �' � � / G Q. <br /> x�. r <br /> If abovc does not apply;folCow guidelines bclow: <br /> 1. CONTRACT PYtYC� * is 1.25%of contract pricc with a(lvtinimam�'ce of$50.00} <br /> x.Ol2S$ <br /> ��"""�. <br /> � (con�r�ct price) (minimum S5A.00) <br /> 2, S'X'A�T�SURCHARGE � �C� <br /> _, 1 � x.00OS $� � <br /> (COntmC�PriG4) <br /> 3. POSTAGE&I-IAND�,[NG(Only on Mail-In Applications) $ 2.U0 <br /> 4. TOTAL P��iMIT��E(Add C,ines 1-3 Abovo) $ � � <br /> � * CONT�tAC`'i' P1tICE or JOB GQST means tha actual or estimated dollar amount chargzct for the ' <br /> permitted work 'rncluding materials,labor,profit,and other fixed costs. Ft is Chc amount to be charged � <br /> Co t6o customer for the work done. If any matcrial,cquipment,labor or installations arc furnished by <br /> the owner,eenant or any other party,the reasonable market valuc of such items must be added to tho � <br /> estimated cost or contract pricc for permit fee purpos�s, in the event that there is a dispute on the <br /> amount of the job cost,the City may rcquost the submission of a signed cop�of the actual contract. <br /> � ����J � Y �/��� '/v✓V� �" � r �J' <br /> � �� �� �/N <br /> f F, �: <br /> Y` <br /> The undersigned hereby applics to the City for issuance of a Mech&nical permit, agrees to do all <br /> work in strict accordance with the ordinances of the City and the regulations of the State af <br /> MinnesoCa, and certifies that all �statements made on this application are cornplete, true and <br /> corr�ct. <br /> C. r j <br /> Applicant's Signature: _ � Date: �� `�1 �� <br /> 3 <br />