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i <br /> .� � ��C��� �. W�� <br /> ��� -�� C��ov� <br /> � �`�r��� �� S a U�Q <br /> lip ance that meets all three of the following requirements: <br /> C���"' !electrical or gas service. <br /> �s;excludine the cost of the fixture or appliance:and <br /> �� r ' x� d by the homeowner or licensed contractor. <br /> l.X� <br /> , Cost of Permit $ 15.00 <br /> �` I_ � i Q �� O a C�( State Surcharge $ 5.00 <br /> J `t. � �6I Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> �13s,��(� x.0125$ ,� ,� � �i Y <br /> (contract price) (minimum S50.00) <br /> 2. STATE SURCHARGE � <br /> I �`� rOOl� x.0005 $ �2 � <br /> (contract price) <br /> 3. POSTAGE&HANDLING(On(y on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ <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 instaliations aze furnished by <br /> the owner,tenant or any other party,the reasonable mazket 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 /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, 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: <br /> 3 <br />