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Sep. 26. 2013 2: 16PM No. 7262 P, 3 <br /> , ,.��LRh�lTT,��$C�;.�;�;ATSON'(S) I <br /> '� ' .:Bi�$Bb p��=200 STA`TB�TA'I'�UE � <br /> I <br /> ❑ Yes,this section applies i <br /> The replacement of a$&�i�ntial frxtua'e or appliance that meets alt three of the following requirements: � <br /> 1. �oes not require modrfication to electrical or gas service. <br /> 2. Has a�al cost of�500.40 or less;e cI�c uding the cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeoWner or licensed contractor. <br /> Skip next sect'ron,if this applies; Cost of permit $ 15.00 <br /> SCaCe SurChargt $ 5.00 <br /> Mail-In Fee(T�'Applicable) $ 2.00 <br /> Totel Permit Fee $ � <br /> : . _ ,PE�TT�EB'GAI;GC�';A,TI�SN� .=J B$O'V'�R: 50d;0U:_ <br /> $ <br /> Tf abo�ve does not apply;follow guidclines bolow: <br /> 1. CONTRACT PRICE x is 1.25%of contract prica with a(lV�iulmum Fee of SSOAO) <br /> �,�a� x.0125� ��. �..� <br /> (ConlrflCt priCe) (mfnimum 550.00) <br /> 2. STATE SURCHARGE � <br /> S��°� x.0005 � �'�� <br /> (cOnlrACt priCe) �� <br /> 3. P05TAGE�HANDLFNG(Only pn Mail-I�i Applications) $ �L�OQ <br /> 4. TOTAL P'ERMIT FEL(Add Lines 1-3 Abova) $ ��D. `� ^_ <br /> ■ * CONTItACT PRICE or JpB COST means the actual or estimated dollar amount charged for the <br /> permittod work including materials,labor,profit, and other fixed costs. It is the amount to be eharged <br /> to the customer for the work done. If any mAterial, equipment, labor or installations are fumished by <br /> tho owner,ten��t or any other party,the reasonable market value of such iterns rnust be added ro the <br /> cstimated cost or contract price for permit fee purposes, In the event that there is a dispute on the <br /> amon❑t of the job cost, tha City may request fhe submiss'ron of a signed copy of the actual contract. <br /> .. . . - <br /> . : . . ; . ' . ' -ME�HAI�TTC�T;'FERMTT A�PLZCATI�ON AGRBENiENT�'. = .; <br /> The undersigned hereby applies to the City for issuance of a Mcchanical�ermit,agrces to do all <br /> 'uvork in strict accordance with the ordinances of the City and the regulations of the State of <br /> Minnesota, and certi�es that all statements madt on this applic�Cion are complete:, true and <br /> correct. <br /> Applicant's Signature: �C�l�--�,l��J�� bate: /'� ���] <br /> 3 <br />