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>z���� , � . �� , , .-� ,. , <br /> [k+' <br /> .. , <br /> . • . . , . - , � � �� . <br /> 3f.'" � <br /> : <br /> ��� <br /> � <br /> r <br /> .a. .� �� . � 1 r� z._ . , . � . . .. . . <br /> .. � <br /> ' sr <br /> a <br /> �„ -.... r .��� +' . . ��,�.. ..� ,. .. . , v . �.�..' � :...A , > :..,� . .�_:. .._ ,. . .. <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$500.00 or less; excludine the cost of the fixture or appliance:and <br /> 3. Is improved, installed or replaced by the homeowner or licensed contractor. <br /> Skip next section, if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> � � _ �..: . . . <br /> .. <br /> y <br /> . . <br /> � <br /> � ,� � <br /> --� : �K- .:. - r�a�� � �� e <br /> If above does not apply; follow guidelines below: <br /> 1. CONTRACT PRICE * is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> �►�� ' � x.0125$ <br /> (conVact price) (minimum$50.00) <br /> 2. STATE SURCHARGE <br /> x.0005 $ <br /> (contract price) <br /> 3. POSTAGE&HANDLING (Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ <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 chazged <br /> to the customer for the work done. If any material, equipment, labor or installations are furnished 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 for 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 actual contract. <br /> � ��^,,�t,� & �; <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all <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 /> correct. <br /> Applicant's Signature: � ��' Date: r v �1�� l� <br /> 3 <br />