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� <br /> �r ` � � � .y_ <br /> ���,„�, ������� � ' <br /> ❑ Yes,this section applies <br /> The replacement o esidenrial fu rc r a lian thai mcets all three of the �ig requirements: <br /> 1. Does not require 'ication to electrical or rvice. <br /> 2. Has a total cost of 5500. the cost of the fixturo or appliance:and <br /> 3. Is improved,installed or re I is omeowner or licensed contractor. <br /> Skip next se ' ,if this applies; Cost of Pertnit S 15•00 <br /> State Surcharge S 5•00 <br /> Mail-In Fee(If Applicable) <br /> , Total Permit Fee S <br /> 41 Ik'`��� ' <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimnm Fee of 550.00 <br /> 3, Un� X.0�25� <br /> ������� �.��m�m sso.ao� <br /> 2. STATE SURCHARGE <br /> x.0005 $ <br /> (contisccprice) <br /> 3. POSTAGE Bc HANDLING(Only on Mail-In Applications) S 2.00 <br /> 4. TOTAI,PERMI7'FEE(Add Lines 1-3 Above) S <br /> ■ *CONTRAC'f PRICE or JOB COST means the actual or estimated dollaz amount charged for the <br /> permitted work including materials,labor,proSt,aod other fixed costs. It is the amourrt to be charged <br /> to the customer for the work done. If any material,equipment,labor or installations are fumished by <br /> the owner,tenant or any other party,the reasonable market value of such items must be added to the <br /> estimated cost or contract price for permit fce purposes. In the event that there is a dispuLe on the <br /> amount of the job cost,the City may request the submission of a sigued copy of the actual contract. <br /> i��ti°: <br /> T'he undersigned hereby applies to the City for issuancyjof a Mechanical Permit,agrees to do all <br /> work in sirict accordance with the o ' ances of�'City and the regulations of the State of <br /> Minnesota, and certifies that all,�te ents �qde'on this applicarion are complete, true and <br /> cortect. /1 <br /> , /I f � <br /> , �;/'��� /� �e j.� ; I/�' ���j L <br /> Applicant s Signature: �; (�' F� DaTe. i� " i G"�' � <br /> 3 <br />