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� <br /> , <br /> a-' <br /> t <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixtiue or apoliance that meets all three of the following requirements: <br /> 1. Dces not require modification to electrical or gas service. <br /> 2. Has a tot�l cost of$500.00 or less;excludin¢the cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> If above dces not apply;follow guidelines below: <br /> 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimnm Fce of$50.00) <br /> � x.0125$ ,.s�•O�� <br /> (c etract price) (minlmam SS0.00) <br /> 2. STATESURCHARGE , � <br /> �/'� x.0005 $ . .�U <br /> ° (contract price) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ ��• �� <br /> ■ * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the <br /> permitted work including materials,labor,profit,and other fixed costs. It is the amount to be charged <br /> to the customer for the work done. If any material,equipmeut,labor or installations are fiunished by <br /> the owner,tenant or any other party,the reasonable market value of such items must be added to the <br /> estimated cost or contract price for petmit fee purposes. In the event that there is a dispute on the <br /> amount of the job cost,the City may request the submission of a signed copy of the actual contiact. <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all <br /> work in strict accordance with the ordinances of the City and the regulations of the State of <br /> Minnesota, and certifies that a11 statements made on this application are complete, true and <br /> correct. <br /> Applicant's Signature. Date: ����%���� <br /> 3 <br />