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11-10—'17 12:41 FR4M— T-124 P0006/0007 F-514 <br /> i j l'�^ .',�1!�' � � KkA� . ' f... ,. 8'..r!f' ..r�•. ,4 ,i,�, <br /> :�+'�i�• ,��'�� �i�;"Q�� •�j .- � ' 3 �i, E <br /> :�r �'��� �� ,��.J�2� �` "+� rl PE� �i <br /> tr � �..�. ,.. <br /> ❑ Yes,this section applies <br /> 1. Does not require�nodification to electrical or gas service. <br /> 2. Has!t totAl Cost of$500.00 pr less;exclud'111�ihe Cost of the fiXturo or appliance�and <br /> 3. Is improved,installed or replaced by tite homeo�vner or lieensed eonhactor_ <br /> Skip next section,if this applies; Cost of Pennit $ 15.0� <br /> State Surcharge $ 5.00 <br /> Mait-In Fee(Tf Applicable) $ 2.U0 <br /> Totni Permit Fee $ <br /> ��x�; '���' �. �" t �& �`y+�.�,�' F t.�� r�, Q '��.�T.��k.9��. � <br /> If above doos not apply;follo�v guidel'u�es belocv: <br /> 1. CONT'RACT PRICE Y is 1?5%of contract price�vith a(141inimum�'ee of$�0.00) <br /> j x.0�25$ s�a� <br /> consracc price) (lnfnimubi 550.00) <br /> Z. STATE SURCHARGE � ��� �y� <br /> x.0005 $ �i�'� <br /> (contract price) <br /> 3. POSTAGE�HANDI,INCr(Only on M�il-Yn ApplicAtions) $ 2.00_ <br /> �7 7 <br /> 4. TOTAL PER1V117'F�E(Add Linrs 1-3 Above) $ �[�� <br /> ■ * CONTYtACT P1tYCE or JOB COST meaos ti�e actual or estimated dollar amount charged for the <br /> perrnitted��rork including xnateriais,tabor,pro�t,and other fixed costs. It is the amount to be charged <br /> to the customer fot't11e work dotie. If any material,equipment, labor or in3t&Ilations are furnished by <br /> thc owner,tea�ant or any other parCy,the reasonable market value of such items must be added to the <br /> estimated cost or contrdct prieZ for permiC fee purposes. In the event dlat there is a dispute on the <br /> amount of t}�c job cost, the City may request the submission of a signed copy of the actu�l contract. <br /> ��' ��� � ^�+. ` °r: <br /> i4 ..r��; <br /> The undersigned hereb� applies to the City for issuance o�'a Mechanical Permit, agrees to do a11 <br /> �vork in striet accordance with the ordinaaces of the City and the rzgulatians of the Stale of <br /> Nlinnesota, f►nd cer[ifies that all statements made on this application are camplete, trtte and <br /> correct. <br /> Applicant's Signatu. Date; �Q <br /> 3 <br />