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05-20—'15 14:58 FR4M— T-827 P4003/0004 F-008 <br /> ❑ Ycs,this scction applias <br /> The replacement of a�tesidential fixture or applianct that mccts all three of the following rcquiroments: <br /> 1. Dots not require modification to electrical ow�as service. <br /> 2. Has a total eost of$500.00 or Iess;oxcludin�the cost of the fixtuee or appliance:and <br /> 3. ls improved,installed or replaeed by the homcowner or licensed conhactor. � <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $,�„_,,,,,,�QQ ' <br /> Mail-In Fco(If Applicablc) $ 2.00 <br /> Tnt�ll Permit Fee � <br /> � � � <br /> 0 <br /> ! <br /> If above does not apply;follow guidelines below: � <br /> 1. CONTRACT PWCE *is 1.25%of contract price with a(Minimum�ee of$50.00) ' <br /> 4896.15 i�;i�;OX2�5.��'"���'_=`;��fi��i��;�;,��r��+���4x ; <br /> ����±D�CS;�] .(i�li�A. .!�lDi:� ;'�9, � <br /> 2. STATE SURCHARGE ' <br /> 4816.15 x;;,._:NA,;;;,. 2.�41 E <br /> �>rQaP3�:��� <br /> �(c' �C..���)! N <br /> 3. E'OSTAG�&HA.N�C.INO(Oniy on Mail-In A lications ��:00:';Y'`e`��<.'�.:;; <br /> . pP ) �'3 ,;: �.; <br /> i <br /> , � <br /> 4. TOTAT.P�RMIT�E�(Add�,ines !-3 Above) .�,, �� .�r� 1 r � , <br /> i��+w-�*��..���` -1iA���,IC':1��'`"����o� <br /> � � CONTR.ACT PR10E or JOB COST means the actual or estimated dollar amount charged for the <br /> permitted work including matarials,labor,profit,and other fixed costs. 1t is the amount to be eharged <br /> to the customer for thc work done. If any material,equipment,labor or installations are furnished by � <br /> the owner,tenant or any other party,the reasonable mawket�value of such items must be added to the <br /> estimated cost or contract price for permit fee purposes. 1n the event that there is a dispute on the � <br /> amount of the job cost,the City may requesf the submission of a signed copy of lhe actual contl'act. <br /> i <br /> i + e, <br /> f <br /> � <br /> The undersigned hereby applies to the City for issuance of a Mechanieal Perrnit,agrees to do all ': <br /> work in strict accordance with the ordinances of the City and the rzgulatipns of the State of j <br /> Minnesota, and certifies that ali statements made on this application aro complete, true and <br /> COI78CL. <br /> Applicant's Signature: l.P'LWI� ��"� ���;::,� 5/20/15 <br /> ,.. <br /> 3 � <br /> , <br /> � <br /> � <br /> i <br />