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M .... r ���m'Y�'iN'� .��r'�w'�"� � * ` �v"a�'�'�� r�,,� � ;,,� ��` � s� . <br /> �� �,� y.*sH' 1 � as. e� te A � ;2�� ``.�yf�,«! 3"w' <br /> ' �K � ,;..�,`�.� � ���f `�'v+� .�r , i ,'�`,!�,, �.,,��FF.-��'�',�,•tf��ry ��).�J�1��4.�. <br /> .�,n <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or anpliance that meets all three of the following requirements: <br /> 1. Dces not require modification to electrical or gas service. <br /> 2. Has a total cos of$500.00 or less;excludine the cost of the Sxture 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 Surchazge $ .50 <br /> Mail-In Fee(If Applicable) $ 1.50 <br /> Total Permit Fee $ <br /> ,��.��.�' �:.a�r����'�������� Ar����'.��"' �~ `�C�MM���y� N'il�, � h <br /> �tK. k <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimnm Fee of$35.00) <br /> � OQ <br /> � x.0125$ <br /> (cont�act price) (minimum 5. ) <br /> 2. STATE SURCAARGE **Add the State Brld'�Code Div.Surcharge(Minimam Fee of 5.50) <br /> � � 4� <br /> "� x.0005 $_ . <br /> (contract�xice) (minimiun S .50) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) � , <br /> ■ * CONTRACT PRICE or JOB COST means the actual or estimated dollaz amount chazged for the <br /> pernutted 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 fuinished 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 e�,ent that there is a dispute on the <br /> amount of the job cost,the City may request the submission of a signed copy of the actual contract. <br /> • **The STATE SURCHARG�is.0005 of the Building Departme�at(952)249-4600 for the price. <br /> ��''A.kV,l�t'A.4s�Li"���C`�sl,�i+�.��l�i°:r��� � <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 are wmplete, true and <br /> correct. <br /> t ��+�' <br /> Applicant's Signature: Date: <br /> ' .R.e�et�orm <br /> � � _ _ , 3 <br />