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04-01-'16 15:54 FR4M- FIRESIDE T-816 P0003/4004 F-246 <br /> . <br /> f <br /> , <br /> t. � .iC F O . � <br /> � � �%� � i <br /> ❑ Yes,this section appl9ts � <br /> i <br /> i <br /> The replacement of a Itesiyjqn;ial fixture or appliance that meets ail thrcc ofthe foilowing requirements: � <br /> 't <br /> l. Does not reyuire modifcation to elecprical or�as service. � <br /> 2. FCa3 a total eost of$500.00 or Icss;excludine the cost of the fixture or applianct:and t <br /> 3. Ts improved,installzd or r�placed try the homeowntr or lictnsed contractor. � <br /> Skip next scction,if this applieS; Cost of Permit $ I5.00 � <br /> State Surcharge $ 5.00 � <br /> Mail-in Fee(If AppliCable) $ 2.00 ; <br /> Total Permft�ee � <br /> �- ��:•� _- - _- - ' ' ' <br /> -- _� �5'¢���:��.x.� .:.."�� <br /> :�._z�._ . _ _ s _ .. _._ _ .. ; <br /> � <br /> [f above does not apply;foliow guidelines below: � <br /> i <br /> ! <br /> 1. CONTRACT p�LCC� *is 1.25%of contract pricc with a(Minimum Fee of$50.00) � <br /> � � x:.,0125$ � �7(/:,-�:: :% � <br /> . <br /> . ..tfacfpiiq3)� ;(ro�iiini'uni$30.U0).: <br /> 2. S'Y'A'Y'E SURCHARGE y� � <br /> xi:0�UQ5.'$: J ; <br /> `.conttracrjpriceS' � ; <br /> 1 <br /> 3. POSTAGE&HANDC.INCr(Only on Mail-In Applications) �$' -2.00 :`.�:� �"��= <br /> .. i <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) :$•^':'�.J'��;:`�.•':::.::`�'�;� ' <br /> • * CONTItACT'p1tYCE or JOB COST means the actual or estimated dollar amount charged for the � <br /> permitted work including materials,labor,proFt,and ather fixed eosts. It is the amount to be charged � <br /> to the customer for thc work done, If any material,equipment,labor or installations are furnished by ' <br /> the owner,tcnant or any other parry,the reasorrable market value of such itcros must bo addtd to tht <br /> estimated cost or eontract price for permit fco purposes. In the event that there is a dispute on the <br /> amount of the job cost,the City may rcquest r.he submission of a signed copy of the actual contract. t <br /> � <br /> ! <br /> i <br /> � <br /> - � - _ _ _ _ a—�_- ' — " - ".:��'.�S:e=' A� '� 1 <br /> - -- � <br /> i <br /> The undersigned hereby applies to the Cit�for issuance of a Mechanical Permit,agrees to do all � <br /> work in strict accordance with the ordinances of thc City and the rcgulations of the State of <br /> Minnesota, and Certifits that all staternents made on this appliC&ti0n are COmplete, CruC and � <br /> correct. <br /> R <br /> ApplicanC's Signature: - C��.e�--..-�-.._ ;DaY�: (� <br /> 3 <br />