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04-08-'15 16:28 FROM- T-712 P0003/0007 F-875 <br /> �. <br /> i <br /> � + <br /> i <br /> ❑ Yes,this section applies � <br /> � <br /> The replacement of a Residential fixture or appliance that meeu all threz of the following requirements: <br /> 1_ Does not reyuire modifieation to eleetrica!or gas service. ` <br /> 2. Has a total cost of$500.00 or less;cxeludine the cost of the fixture or appliance:and i <br /> 3. Is improved,installed or replaced by the homeowner or ticensed contractor. <br /> Skip noxt section,if this applies; Cost of Permit $ 15.00 <br /> State Surohargc $ 5.00 <br /> Mail-Tn Fee(If Applicable) $ ?.00 <br /> Total Permit Fee $ <br /> � <br /> i <br /> Q 9 <br /> If above does not apply;follow guidelines below: <br /> 1, CONTRACT PRICE '�is 1.25%of contract pricc with a(Minimum��oP$30.00) <br /> � � �� x.0125 S �� �1.� <br /> (cont►EU prlCe) {mioimum SSO.Op) <br /> 2. STATE$C�YtCHAItCE �f j� , n� <br /> � L w x.0005 $ � ��� <br /> (contract price) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ ?.00 <br /> +� � <br /> 4. TOTAL PERMIT FE�(Add�.unes l-3 Above) $ . <br /> ■ � CONTRACT PRICE or JOB C�ST mzans the actual or estimated doilar amount charged for the � <br /> permitted work including materials,labor,profit,and other fixed costs, It is the amount to be eharged � <br /> to the custamer for the work done. (f any material,equipment, labor or installations arz furnished by , <br /> the owner,tenant or any other party,the reasonable market valut of such items must be added to the t <br /> estimated eost or canUract price for permit f� purposes. In the event that there is a disputa on the ' <br /> amount of the jab cost,the City may request the submission of a signed copy of the actual contracC. � <br /> r <br /> � <br /> . . �,� .l..'�l4f.:M.. y�K' � <br /> ,�.y��y1p� �,y��.� � '7F. t' �,� f �l s•� C+nYi� Av�. <br /> �7GCiNi7Jl'47J9:9.'S"'� ��C '� •,:�5'i:,\�S„'`�''v>i%�'AS.:7'r�iYlr.'�7:l, <br /> The undersigned hereby applies to the City for is3uance of a Mechanical Permit,agrees to do alI <br /> work in strict accordance with the orclinances of the City and the regulations of the State of <br /> Minnesota, and certifies that all statemeni� made on this application are completC, true and <br /> correct. <br /> Applicant's Signature: Date: '� <br /> 3 <br />