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r � <br /> v <br /> - 3Y 1 1 �` „ 7 .M ... l< :-+ �rv i�.. "' '�.�: <br /> � :.i�Ir�l� 5� .�� *�..� f '4.� <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requirements: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excludine the cost of the fixture or appliance:and <br /> 3. Ls 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 /> Tota!Permit Fee $ <br /> ���'�'. , `;������ : . °S •-���3�� �Q' .:.. <br /> If above dces not apply;follow guidelines below: <br /> 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimam Fee of 550.00) <br /> 7O1�'�. L'`t� x.0125$ �7•s� <br /> (contract price) (mieimom SS0.00) <br /> 2. STATE SURCHARGE **Add the State Bldg Code Div.Surchazge(Minimum Fee of 55.00) <br /> x.0005 $ S• �� <br /> (contract price) (mioimam S 5.90) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) S 7 7•SD <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 furnished by <br /> the owner,tenant or any other party,the reasonable mazket value of such items must be added to the <br /> estimated cost or contract price f�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 of t�e actual contract. <br /> ■ **The STAT'E SURCHARGE is.0005 times the Contract Price or a minimum of$5.00. <br /> _ � .. . . , <br /> �, a, ��� <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 all statements made on this application aze complete, true and <br /> correct. <br /> ApplicanYs Signature: Date: .? �/ <br /> �'��i�, 3 <br />