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Ma� �05 2014 3: 23PM HP LRSERJET FRX p. 5 <br /> ❑ Yes,this seclion applies <br /> 'Iho replacement of a Residentisi fixture or aonliance that meets all three of d�e following requirements: <br /> 1. �not require modificetion to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less; cl in the cost of the fixture or applianca:and <br /> 3. Is improved,installed or replac�i by the homoowner or licensed cocmacGor. <br /> Skip eext seqion,ifthis applies; Cost ofPermit $ 15.00 <br /> State Surcharge $ 5,00 <br /> Mail-In Fee(If Applicable} $ 2,00 <br /> Total Permit Fee $ <br /> If above does rrot apply;follow guidelines below: <br /> 1. CONTRAGT PRICE *is t.23%of contract price with a(Minimum Fee oP 550.00) <br /> �'��rao ' X.o�zs$ 1'9a, 7S <br /> (contract price) (mi ntsum SSU.60) <br /> 2, STATE SURCHARGE �n� <br /> � 7� x.0003 $ �7� <br /> (contract prica) <br /> 3. POSTAGE dt H.4NDLING(Only on Mail-In Applicatians) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines l-3 Above) S ���� <br /> ■ '" CONTRACT PR.ICE or JOB COST means ihe actuai or estimated dollar amount charged far e <br /> pertnitted wodc inc[uding materials,labor,profit,anci other fixed costs. It is the amaunt to be charg <br /> to the cusWtner for the work done, If any material,equipmen� labor or installations are fumished <br /> the ormer,tenant or any other party,the reasonable market value of such items must be added to e <br /> estimated cost or con�ract pric� for permit fee purposes. In the eve�t that there is a dispute a� e <br /> amount of the job cost, tho City may request the submissioa of a signed copy of the actual con <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit,agrees to do 11 <br /> work in strict accordsnce with the otdinances of the City and the regulations of the State f <br /> Ivliunesota, and certifies that all merrts made on this application are complet�, true d <br /> correct. <br /> ApplicanYs Signature: Date. ��l� <br /> 3 <br />