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� <br /> r '' <br /> PERMI'fi,i"����.:��.A'1'�C}i�?�S� <br /> BA�EI?{��F'��{�}2 �TA'�`E�TATUE <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the follo���in�requirements: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Has a total 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 /> �'�'�RMIT FE�CAL,�C:T�.t�`T�fl � -J4��U�R$�t}(I�4_il.. ;: <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum F'ee of$50.00) <br /> 2,500.00 x.0125$ 50.00 <br /> (contract price) (rtYenimum$50.00) <br /> 2. STATE SURCHARGE **Add the State Bldg Code Div. Surcharge(n•tinimum Fee of 55.00) <br /> 2,500.00 x.0005 $5.00 <br /> (contract price) (minimum$5.00) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(.�dd Lines 1-3 Above) $55.00 <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, equipment, labor or installations are fumished 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 permit 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 af the actual contract_ <br /> ■ **The STATE SURCHARGE is.0005 times the Contract Price or a minimum of 55.00. <br /> I�iECH�I��:,;��R�T Ai'PL�C��'IE�1��.GrR�Ei4��. .:: <br /> The undersigned hereby applies to the City for issuance of a Mechanical Pe��riit, 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 all statements made on this application are complete, true and <br /> correct. <br /> Applicant's Signature: Date: 03/Z4/11 <br /> R'83@��#'3t"tYt ' 3 <br />