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03-24-'16 12:13 FROM- F I RES I DE T-781 P0003/0004 F-198 <br /> . <br /> X ( �? <br /> 1�u�s:�. �. �r i'��_.i r F �...�'J~E� . . . � � �� ��. 'lfr��3.�c-...r�^�^'Y �R �: <br /> .Y a��3�x5�iK�F�e'�s�'�� Y�Si ,F x� ���.5 2 ,�'���?��',r � ��t �� 3� ' <br /> , ` � �M <br /> �r��:d��..�x��u�b+�ad�s.��.n -�����.�_ _"�5��__.._�_._ _.t i�• " ����,''i�s�t.r.c.�.�E'����. �'wz.� � <br /> [,) Yes,this section applies <br /> The replaecmenC of a Residential�xture or applianee that mccts all three ofthe follow'rng reguirements: <br /> 1. l�oes.nQt require modifieation to electrical or gas service. = <br /> 2. �as a total cost of$500,00 or less;excludine the cost of the fixture or applianez:ar►d <br /> 3. Is improved,installed or repl�ccd b�the homeowner or licensed contractor. <br /> Skip next section,if this appl'res; Cost of Permit $ 15,00 <br /> Stafe Surchargt $�,_w„�Q,.Q <br /> Mail-In Fee(lf Applicable) $ 2.00 <br /> ToEal Perrnit Fco S <br /> �1'�x-����� c ?nc' .6� � p�£�4 _.�'°I L D �'�An„ .�tr�F �} � � ' <br /> Tf above does not apply;follow gu;delines btlow: ' <br /> i <br /> 1. CONTRACT p12CC� '�is 1.25%of contract p�c,�with a(141in➢mutn Fee of$SOY00) � <br /> r,, b � <br /> 5� � x.012$$ . � � . . <br /> '(onl��ciprice) (n�in;mumSso.00) <br /> 2. STAT�S�Y2�:�ATiG� � ! �" ,°'� <br /> �/(0 x'.04QS $ �� � <br /> ( ntract price) s <br /> 3. POSTAC�E&HANDLING(Onty on Masl-Tn Applications) $� '�� ' '�,� <br /> � y`^(�, <br /> W � <br /> 4. TOTAX,��RMYT�'��(Add Lints 1-3 Above) $' .`� ' `�� <br /> :` <br /> ■ � CONTRACT PR10E or .�OB COST means the actual or estimated dollar arr�ount charged for the <br /> ptrmitCed work incfud'rn�materials, labor,profit,and other fixed costs. lt'rs the amount to Ue charged : <br /> So the custorner for the work donc_ If any material, equipment, labor or installations arc fiirnished by <br /> the owner,tenant ar any othcr party,the reasonable market vah�c of such items must be added to the , <br /> esfimatcd cost or contract price for permit fee purposes. in ihe event that there is A dispute on the <br /> amount of thc job eost,the Ciry may request the submission of a signed copy of the actual contract. � <br /> ; <br /> � <br /> ' !�7� �/( ) yy�.a ,Q /''� , .� 1{ <br /> i�G ?a��,k��,�`.^i 1�-ti!�k����_:�_ � �1f F�'���H���Ld:.�i.. �. _��1,1�,.�._._�� �a�"�tl.t�y��,k��l I <br /> �...� . � <br /> The underSi$ned hereby applies to the City for i5suance of a Mechanical Perm'rt, agrees to do all I <br /> work in strict aceordanee r�ith the ordinances of the City and the regulations of the State of <br /> Minnesota, and certifies that all statements made on this appliC�C►on are Complete, true and <br /> coxrect. <br /> Applicant's Signature: � ��_ n.ate: � �/y `� <br /> 3 <br /> � <br />