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i <br /> . <br /> �� �r�u � <br /> i�ry�"��2 m �a�„�h �, � �`� � . <br /> . <br /> ,4 r#.,��"�,�`� �x,._ �� '' ' - <br /> .s.4; �NR ..�Y���w. „r, -..zc <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 toffi1 cost of$500.00 or less;excludic�the cost of the fixture 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 Pernut $ 15.00 <br /> State Sutcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> ,y ; Y e _ _ � <br /> ,. ,. . <br /> ; , .�,Y� ��4�`� t, � ��, ;�`•f� �` <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PItICE * is 1.25%of contract price with a(Mmimum Fee of$50.00) <br /> 1 l. �oa.oo X.o�z5$�`�2,�a <br /> (contract price) (minimum 550.00) <br /> 2. STATE SURCHARGE � I' ��� �a x.0005 $ ��,�� <br /> ! , <br /> (convacc price) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ ���i 2� <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 chazged <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 parly,the reasonable market value of such items must be added to the <br /> estimated cost or contract price for pemut 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 the actual contract. <br /> ���������F,�� <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all <br /> work in sh-ict 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 complete, true and <br /> correct. <br /> Applicant's Signature: �C�,�il{,��/�2�'��� Date: (� � ��� I � <br /> --� <br /> �� � �_���� ��� y �.� <br /> � <br /> � �, � <br /> 3 <br />