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11-20—'14 13:39 FROM— T-197 P0003/0406 F-318 <br /> i <br /> E <br /> E <br /> t <br /> � <br /> � Yes,this section applies r. <br /> � <br /> The replacemcnt of a Residential fixture or a liancc that meeu a11 three of the following requirements: ; <br /> 1. boes requirc modification to eleatrical or gas serv;ce. ' <br /> 2. i�as a total cost of$SU0.00 or less;excludin the cost of the 6xfure or appliance:and � <br /> 3. Is improved,installed or repiaccd by the homeowner or licensed contractor. <br /> Skip neatt section,if this applies; Cost of PormiC $ 15.00 � <br /> State Surcharge $ 5.U0 I <br /> Ma41-Cn Fee(yf Applicable) $ 2.00 <br /> Total Permit�'ee $ � <br /> ,�� � ?� 1,.* (� (5�:�"''�i� '.:4s'R�yi� a�: <br /> ;St!,J!.lA+ .4'� i � i 1: ��' � .s%' J �n.{..����4L,�. NS.��,�.'r�Np,�nlj.}?Yi.Y`^fAty''i.�YJaeVe � <br /> i <br /> . { <br /> 1f above docs oot appty;follow guidotines below: � <br /> �. CON'Y'RACT PR1C$ �'is 1.25%of contract priee with a(Minimum Ree of 550.00) <br /> ��"1�Q0 �D <br /> �.o,�s� �� �— <br /> (conaact prica) (minimum S�.do) <br /> 2. STAT�S'C1�Af:�ARGE �"J <br /> ` O x.0005 $ <br /> (contract pricc) <br /> I <br /> 3. POSTAGH&HANDLING(Only on Mail-Cn Applications) $ 2.00 � <br /> ( n�j'[�� I <br /> 4. TOTA�.P�RMIT FEE(Add T�ines 1-3 Above) S �Y ✓'�`� i <br /> � � CONTRACI' PR10E or J0� GOST means thz actual or estimated dollar amoune ctrarg�ci for the <br /> perm;tted work ineluding materiats,labor,profit,and other fixed costs. It is the amount to be charged <br /> to the castomer for thc work donz. �f any material,cquipment, labar or installations are fumished by <br /> the owner,tcnant or any other parry,the roasonablc market value of such items must be added to the <br /> estimatcd cost or contract price for permit fee purposzs. In the event that there is a dispute on the <br /> amount of the job cost,the City may request the submission of a signod copy of the actual contract. <br /> i <br /> y,. � � ; � ' <br /> :��yy. +e'X�F �'iI �� ' .(,ryg�� ;� ' ,'�,i ..y�: 9' ��<' i�Rr: !6.� ��' +'�� • <br /> M4. a_ _I_ Tf ':w"..•� I <br /> f <br /> The undersigned hereby applies to tho Ciry for issuance of a Mochanical permit,agrees to do �ll � <br /> work in sCrict accordance with the ordinances of the City and the regulatiqns of the State of ` <br /> Minnesota, and certife3 that all statements madC on this application are complete, true and � <br /> correct. <br /> � Il � � <br /> Applicant's Signature: DaCc: � ��! � <br /> � <br /> 3 � <br /> h <br /> ( <br /> I <br />