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, �. <br /> ♦ <br /> , d ��.., t ���' ,�S <br /> � � . .r x: , y ��� <br /> Y � �G <br /> �' :. a.^ .�-D '-: <br /> � <br /> . , .r ..5 . . � '��- ij - ,, :. . ,_ , . i' S <br /> , �i � <br /> x <br /> t 2 <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 total cost of 5500.00 or less;excluding the cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or lic�sed contractor. <br /> Skip next section,if tlus applies; Cost of Permit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> ` P�T FEE C�.Ct���.. . ;�:. . ,�. �: . . .� � <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$511.00) <br /> 3%Z�• `� x.0125$ sn= �� <br /> (contract price) (mieim�m 550.00) <br /> 2. STATE SURCHARGE **Add the State Bldg Code Div.Surcharge(Mioimum Fee of 55.00) <br /> 3 a�•� X.000s $ S. � <br /> (coetract price) (misimum S 5.00) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applicarions) � 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ S 7- �� <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 charged <br /> to the customer for the work done. If any material,equipment, labor or installations are fiunished 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 far 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 ach�al contract. <br /> ■ **The STATE SURCHARGE is.0005 times the Contract Price or a minimum of$5.00. <br /> t�'�+`����:�r��i�'�� '.. " : . �I�-.., . ; � ; . . <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do a11 <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 /> conect. <br /> ApplicanYs Signature: 7��j��� Date: 01 I/ <br /> 3 <br />