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. __.__.__._____.___-.-,-----___.__ <br /> . � <br /> ❑ Yes,this section appties <br /> The replacement af a Residential fixture or a Ipn iance that meets atl three of the following requirecnenrs: <br /> I. Does not require m�ificarion to clectrical nr gas serviee. <br /> 2. Has a wtal cost of�SQQ.(�or iess; xcl in tt�e cost of the fixturo or appliance:and <br /> 3. ls impr��•ed,instatled ar replaced by the homcow�ner or licensed contractar. <br /> Skip next section,if this applies; Cost uf F�msit � I S•Od <br /> State Surcharge $ 5•00 <br /> 14fai1-In Fee(Tf Applicable} $ 2.OU <br /> Total Permit Fee 5 <br /> If above does nat apply;fatEow guidelines below: <br /> 1. CONTRACI PEUCE •is t.25%of cantract price with a(MinEmu�n Fee of 550.80) <br /> � ����,iJi"i x.0125 S .f�� ,t�t� <br /> tcoaaact priee) (�nlntmom S�l.�y <br /> 2. STATE SURCNARGE <br /> ��f����`'`� x.0005 $ �_JD <br /> (contract prics} <br /> 3. PC35�`AGE&HAND[.tNG(Oniy on Mail-[n Applications} S 2.pp <br /> d. TOTAL PERMIT�EE(Add Licaes 1-3 Abave} S I t/����� <br /> • * CC)N'I'RAC"P PRICE or JOB COS7' means the aetual or estimated dollar amouztt charged for the <br /> ptrmitted work inctuding materials, labor,profit,and ather fixed costs. Tt is the amount to be charged <br /> to the cusromer for the work done. if any materrial,equipment,labor or instaUations are furnished by <br /> the owner,tenant or any other parry, the reasonable market value of such items must be added to the <br /> estimated cost or contraci price for permit fee purpc�ses. In the event that there is a dispute oa the <br /> amount of thc job cost, Che City msy rcqucst the submission of a signcd copy of the actual contract. <br /> i <br /> ,� . � .. <br /> � _,:ffi _ <br /> , The undersigned hereby apglies to the City for issuance of a Mechanical Permit, agrees[o do all <br /> '' work in strict accardance witt� the ordinances of the City and the re�ul�tians af the Siate of <br /> Minnesota, and certifies that all statements made on this application are comp(ete, �ue and <br /> correct. <br /> ...—.",.' <br /> _ �'_---�.. ��'�i� � <br /> Apptieant's Signature:�,Jr.�.Y--' _ Uate: � <br /> � <br /> 3 <br />