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02-04-'16 10:25 FROM- T-631 P4003/4004 F-012
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<br /> [,� Yes,this section applias
<br /> Thc replac�mcnt of a Ctesid i 1 fixture or a liancc that meets all three of the foliowiog requirements:
<br /> 1. I�oes not require modification to electrical or gas servicc.
<br /> 2. Has a tot$ cost of$500.00 or Iess;excludin�the cost of the fixture or appliance:and �
<br /> 3. Is improved,inatalled or replaeed by tht homeowner or licensed contractor, F
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<br /> Skip next section,iPthis applies; Cost of Permit $ 15.00
<br /> State Surcharge $ 5.00
<br /> Mail-In Fee(if Applicablt) $�Q .
<br /> TotAl Permit F'ee $ �
<br /> :,�,-�s,. . �
<br /> :T;.=�.-==s-._s.;: 5y'4�".,.�_�j�'�����7±y�y �,��,'!r�"_�}�___ ..�i ��{-�j �_,_:Fa-r.='v";'r .. $
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<br /> If above does not apply;follow guidelines below: �
<br /> 1, CONx'XiA.CT pRICE •is 1.25%of contr�ct price with a(lV(inimum Fee of S50.00)
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<br /> 2. STAT�SURC�#ARG� � C�� ��j �
<br /> ��;;OOOS::�$' .�
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<br /> (cbntrae't'price)J
<br /> 3. POSTAGE&HANDLING(Qniy on Mail-In Applications) ;$� ;'2:(30:,��-��` ;:���_�;
<br /> 4. TOTAC�P�RM�'C���(Add L.ines 1-3 Above) ',$�����:''';',;;
<br /> • * CONTRACT PIttCE or JOB COST means the actual or estimated doilar amount charged for the
<br /> permiacd work including materials,labor,profit,and other fixed costs. lt is the amount to be charged
<br /> to the customer for thc work done, lf any material,equipment, labor or installations are fumished by
<br /> thc owner,tznant or any other party,the rcasonabEe market value of such items must be added to the
<br /> estimated cost or eontraet priee for permit fee purposes. In thc cvenk that there is a dispute on ihe
<br /> amount of the job cost,the CiCy may request the submission of a signed copy af the actual eontraet. !
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<br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all
<br /> work in strict accordancc with tha ordinances of ihe City and the regulations of the State of
<br /> Minnesota, and certifies that all statements made on this application are eomplete, irue and
<br /> eorrect.
<br /> Applicant's Signature: ��/ ��b�'��` sI?at�;.�� �'
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