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: � <br /> ❑ Yes,this section applies <br /> The repiacement of a Residential fixture or sonliance that mcets all thrce of the following requirements: <br /> 1. oe require modification to electrical or gas service. <br /> 2. Has a tato 1 cost of$500.00 or less;excludine thc cost of the fixture or appliance:and <br /> 3. Is improved,instatled ar replaced by the homeowner or licensed contractor. <br /> Skip next section,if this appli�; Cost of Pennit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) S 2.� <br /> Total Permit Fee S <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE *is 1.25%of coatract price with a•(Minimum Fee of$50.00) <br /> ar,�.a-1� x.0�25$ 5a�rso <br /> ��c�;a� c�mom sso.eo� <br /> 2. STATE SURCAARGE � <br /> �C".DD t � 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) S ���i �O <br /> ■ * CONTRACT PRIc:E or JOB COST means the aetual or estimaieci dollar amount chargcd for the <br /> permitted work including materials,labor,profit,and o�er fixed costs. It is the amount to be charged <br /> to the cusWmer for the work done. If any material,equipmeat,labor or installadons 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. Ia 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 /> The undersigned hereby applies to the City for issuance of a Mechanical Pennit,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 a11 statements made on this application are complete, true and <br /> correct. <br /> Applicant's Signatttre: � Date: � � g / <br /> 3 <br />