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10-21-'14 16:42 FROM- T-094 P0003/0004 F-206 <br /> , � . <br /> , � <br /> _: <br /> ❑ 'Yes,this section applies <br /> z <br /> Thc replacement of a Rosidential fixtur�or appliance that meets all three of the following rcquirements: <br /> 1. Does not require mvdification to electrical or gas serviee. <br /> 2. Has a to cost of$SOO.UO or less;excludin thc eost of the fixYure or applianca:and � <br /> 3. Is imprpved,installed or replaced by the homeowner ar liconsul contractor. <br /> � <br /> Slcip next section,if this applies; Gost of Permtt $ 15.00 � <br /> State Surcharge $ 5.00 <br /> Mail-Tn�'ee(1f Applicable) $ 2.�0 <br /> Toral permit�ee S <br /> � � �• _ � <br /> Tf above daes not apply;follow guidelines below: <br /> i <br /> l, CO1V'Y'RACT PRYC� �is 1.25%of contract price with a(Minimum Fee of$50,00) j <br /> �� �� <br /> C�l��_�- X.oizs s i 1 I � 1--�- <br /> �contracc priec) (minimum 550.00) <br /> 2. STA'�'E SURCHAXiC� r`� �� /' ( <br /> � v�•"-"`� x_4005 $ "—T 1"�r <br /> (cqntraCt price) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.Q0 <br /> � <br /> ( �r� � <br /> 4. TOTAC�PERMIT�'��(Add Lines 1-3 Above) � � � � `J— ' <br /> i <br /> i <br /> ■ '" CONTTtACT PRTCL or JOB COST means the actual or estimated dollar amount charged for the <br /> permitted work including materfals,labor,proft,and othe�fixed cost�. It is the amount to be charged <br /> to thc customer for the work done. !f any materfal,equipment,labor or installaCions are furnished b�+ � <br /> thc owner,tenant or any other party,the xeasonable market value of such iCems must be added to the � <br /> estimated cost or oontract price for permit fee purposcs. Tn the evont that there is a dispuC� on the <br /> amount of thc job cost,the City may request tho submission of a signed copy of thc actual contract. ; <br /> ; <br /> F <br /> B <br /> i <br /> t <br /> 9. � <br /> � <br /> The under3igned hereb�applies to the Ciry for issuanCe of a Mechanical Permit,agrees Co do all i <br /> work in strict accordance with the ordinances of the City and the re�ulations of the State of <br /> Minnesota, and certifies that al! statements made on this application are completz, true and <br /> correct. <br /> Applicant's Signature• - ' Date: l ��� � <br /> 3 <br />