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• �. <br /> � � . <br /> ��� _; <br /> '���Nti <br /> , <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$500.40 or less;excludin¢the cost of the fixture or appliance:and <br /> 3. Is irnpraved,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 /> � ��xa <br /> lf above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE *is 1.25%o�contract price with a(Minimum Fee of$50.40) <br /> 1 ��� � x.0125$ f 1�: �' <br /> (contract price} (minimum$.50.00) <br /> 2. STATE SURCHARGE �J � r /'f <br /> J � �'� ` x.0005 $ l� �� <br /> (contract price) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Apptications} $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ j�—t� C(i�% <br /> ■ * CONTRACT PRICE or JOB COST means the actual or estimated dotlar amouni charged for the <br /> permitted work including materials,labor,grofit,and other fixed casts. It is the amount to be charged <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 perrnit 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 /> �,r <br /> '.�t <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit,agrees to do ail <br /> work in strict accordance with the ordinances af 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: �_ �� _,�,�..� i Date: � � � <br /> ,o,,,, �,� �i� 4� <br /> 3 <br />