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, 02;23-'18 06:40 FROM- T-557 P0403/0404 F-001 <br /> ,., ., ...... �. . <br /> . .:, - <br /> ,.: <br /> : ..,: . . <br /> , PBRIV�XT.:��E.CA�GT�,A,'�ION(S) ; <br /> `$ASfiD�4��:'2 :2 �1. T U <br /> �0 ST �'�.S .A:T �'`�.°� ; <br /> ❑ Yes,this section applies <br /> The replaCtmant of a�i'esidential fixture or appliancz thst meets all three of tl�e following requirements; <br /> 1. Dots not require modification to eleetrical or gas scrviee. <br /> Z. Has a rotal cost of$500.00 or less;excludine the cost of the fixture or appliance:and <br /> 3. Xs impro�ved,installed or replaced by tlie homeowner or licensed contractor. <br /> Skip ne1►t seCtion,if Chis applies; Cost of Permit $ 15.00 <br /> $tAte$UrChArgc $ 5.00 <br /> Mail-7n Frc(Yf Applicable) $ 2.00 <br /> '�otal permit Fee $ <br /> ,: ,� .`;'` .�:::•��:PERiVIYT:.�EE�CA�GU`�:ATI�N(�.._.�J'OBS QVER$S.OQ:OQ''�:,`:�::..::::::�: ':�.:�, <br /> If above does not apply;follaw guidelines below: <br /> I. C4NTRr+►CT PRICE " is 1'?5%of contract pricc with a(Mix�imum�ee ot$50:00) <br /> � � �� fy('���� �( �„-�,- ;,r N��v.��:��..,. <br /> �•"•0..�.�y�. �'�. :4� P���:!A il:A..}'i::: <br /> U F ��o� '' S Q� <br /> a. sTar�s�u�c�A�t�� � (, �j� <br /> _ `� :000;s;>�j ! { <br /> �� ����� <br /> 3. �OSTACy$&HANDLING(Only o�Mail-In Applications) �$' ��;';;a;;�l:�;°'.�; <br /> �,�'..��'�•r�""',�r.`";"-:;. <br /> 4. TOTAL r�XtH�ITT��� Add Lincs I-3 Above •� ;��„;rt' �:::�i;� <br /> � ) $;:;�R'-� r. i,i.�,, ,c:s,:; , <br /> ■ �` CONTRACT PRICE or JpB COST means the actual or estimated dollar amount charged for the <br /> permitted'uvork including materials,labor,proft,and o[her�xed eosts. It is thc acnount to be chargcQ <br /> to tlt;e customer for thc work done. If any material, �quipment,labor or installations are furnished by <br /> the owner,tena�it or any other party,the reasonable marktt value of such itcros must be added to the <br /> estimated cosE or contract price for permit fee purposes. In the event thRt there is a disputc on the <br /> amount of the job Cost, tlle City may request the submission of a signed copy of the actual contract. <br /> . .. <br /> � :'MECI=IANICAL pfi121Vl�T:APPLT.CATION;ACxREEMENT ; �-: :'. :.: <br /> The undersigned hereby applies to the City for issuance of a Mechanic�l Permit, agrees to do all <br /> �.vork in striet accordance with the ordinanees of the Ciry and the reg�xlations of the State of <br /> Minnesota, and certifies that All Statements made on tk►is application are complete, true and <br /> correct. <br /> r' �,r� � —�C� <br /> Applicant's SigRature: ��t��� <br /> 3 <br />