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`�'`�.� ' � . ...�IT'�.. EB. $`"�i�L�A O �5., <br /> 4� r����.:n _ . :;�;` � ;;.,� ASED�OFF a.20 2,ST�A � T� T.L�E <br /> ❑ Yes,this section applies <br /> , <br /> The replacement of a Residential fixture or appliance that meets all three of the following requuements: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excludinQ 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 Permit $ 15.00 <br /> State Surchazge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> _ , <br /> � ;::°� ��""�?���PERMIT�'EE°CAI;CUL'ATIOIV S'�JQBS�OVERy$SQ0.00� <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00) � <br /> 3 vb�, vo X.o�2s$ � <br /> �(contract price) �. ' um$50.0�� <br /> � ��� <br /> 2. STATE 5URCHARGE <br /> 3 v�S.�o X.000s $ �. s 3 <br /> contract price) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERNIIT FEE(Add Lines 1-3 Above) $ S.3. S 3 <br /> ■ * CONTRACT PRICE or JOB COST means the actual or estimated dollaz amount charged for the <br /> permitted work including materials,labor,profit,and other fixed costs. It is the amount 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 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 /> ����`�,�"�' � �ME�HANIC�I��PERN°iI��A'PPlIC��TIOi'���G �". <br /> The undersigned hereby applies to the City for issuance of a Mechanical Pemut, agrees to do all <br /> work in strict 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: �. Date: 3 �/0�/ Sf <br /> 3 <br />