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<br /> ����;��'�`Y�'�'�n ,t��; f e � c� ' ,,�s �t �" U.� � � '�'�3
<br /> '� k� ���s 1M ` r � .� , d� x� +' '�xy w � t rh�k!1j�+?1�^� kaP ���`$ ��r���H� Y'�tg��"�Sti}�q�lf '. � .
<br /> � ,}'t t" 'd y�� �• �...���'..� '(� '� R� �, t uif .a � �# �S' ♦ r
<br /> � � ' ` � �
<br /> � '�a. -:��r.. C i 5��r��4�:v t �;�� .������4+�'�. ��r.}'�.A,�,..•:.�Pt 4 _��r 1 ,�.,5 i a �.a'. ���y�r�,�;a �
<br /> ❑ Yes,this section agplies` �
<br /> The replacement of a Residenrial fixture or appliancb that meets all three of the follow'►a�g requirements:
<br /> ; ,
<br /> L Does not require modificatio�to electr�cal or gas scrvice. '
<br /> 2. Has a t 2a1 c s of�$500.00 or less;exc udin the cost of the fixture>or appJ:�anca:and
<br /> 3. Is improved,installed or repiaced by the homeow�er or licensed contractor.
<br /> ,
<br /> �
<br /> Ski�next section,if this applies; � Cost of Permit $ 15 A
<br /> ; State Surcharge $ .50
<br /> ; Mai1-In Fee(If Applicable) $�4
<br /> ; Tofal Perrnit Fee $
<br /> f:� �,y�j }�� �"{� ,.,4. f� /�►(�
<br /> � . K�r�,�,�.�:�- �,s ; r i�����;.�}.�^�.J�;��.V�.�. ��;L�� i 13�������81!14����hU,N 4 u'� ��:i r Yt,(a,`kv',�'�S��. ... .. .
<br /> If abowe does not apply;follow guideliaes belowi
<br /> 1. CONTRACT PRICE *is 1.25%o�'dontract price with a(Mit�imum Fee of$3$.00j
<br /> ,
<br /> ���� � x.0125$ �c�,��p
<br /> ;(c�ontract price) (minimum$35.00).
<br /> �
<br /> 2: STA'TE SURCHARGE **Add the$tate Bldg Co.de Div.Surcl�arge(Minimum Fee of 5.50)
<br /> i x.4005 $ // y�
<br /> (pontract price) (minimum$ .50)
<br /> 3. POST�GE&HANDLING(Only on Mail-In,Applications) $ 1.50
<br /> 4. TOTAI.P�RMYT FEE(Add Lines i-3 Above) $ u o- �
<br /> ,
<br /> ,
<br /> • * CONTRACT PRICE ar 7�B COST means ithe actual or estimated doilar amount c�arged for the
<br /> pemutted woric including materials, labor,prof�t,and otMer fixed eas�s. It is the amount to be charged
<br /> to the customer for the work done. If any mat�rial,equi�ment, labor or installations are fumi,sl�ed by
<br /> the owner, #enant or any other party, the reaso}�able muket value of such iterns must be added tn tlze
<br /> estimated cost or contract price for pernut fe� pur�oses. I� t1�e event Ch2# 'there is a dispute on the
<br /> amouat of the job cost, the City may request 4he subrnission of a signed copy of the actual contract.
<br /> • **'The STATE StJRCHARGE is.0005 of the$uilding Department at(952)249-4600 for the price.
<br /> � ` � �l'�EC�li�IC,A�=PERI+i�II�' , -P4��GATTQ1�AxA���N�N� � �
<br /> 'The undersigned hereby applies to the City fo� issuance of a Mechanical Permit, agrees to do all<'
<br /> work in strict accoxdance with the ordinance's of the Ciry and the reg�alations of the State of
<br /> Minnesota, and certifies that all statements made o� this application are complete, true and
<br /> correct.
<br /> A�plicant's Signature: Date:' / ' '�"�d'�
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