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10-17—'17 14:01 FROM— T-972 P0003/4007 F-347 <br /> � . �- <br /> �. . . ::.;, :,. , <br /> ,.: <br /> .. <br /> � 'PERMIT.: L�;�AI,CULA�TIQN' S)•; <br /> � <br /> � BA,SED,:OFF.=�2002.STATE STA� .: . <br /> ❑ Xes,this sec�ion applaes <br /> The repIacement of a Residential fixture or s lianee that meets all threc of the following requirements: <br /> 1. Doe�not require madifcation to electricai or gas service. <br /> 2. Has a total eost of$500.00 or less;exeludine the cost of the fixture or appliance:and <br /> 3. 1's improved,iristalled or replaced by the homeowner or licensed eontraetor. <br /> Skip next section,if this applics; Cost of permit $ 15.00 <br /> State Surchargt $ 5.00 <br /> Mail-In�ee(Yf Applic�blc) $ 2.00 <br /> Total permit Fee $ <br /> � �• :1?BRNiIT.FEE.CAY�,CW1aAT'�ON S)=;xQ�S.:�VER:$540.00 ::`;";�.. `.;.�..,..... <br /> If above does not apply;follow guidc�ines below: <br /> 1. CONTRACX'p�C� "is 1_25%of contracC pricc with a(1►�inimum�'ee of 550,00) <br /> 1 a � �,�x�� , Q p, <br /> S' 4 O �?4^A�'�C;?.+D;�R�$i:►�h�m���a:s�-r-;�-t-s+• <br /> I� �,l�S�7�D <br /> 2. S7'AT�SURCHARC� Q� <br /> g�0 x ����;� a � <br /> � <br /> 3. POSTAGE&�AN'DLING(Only on Mail-Tn Applications) � ,��t��y�s.- <br /> � <br /> A. �'OTAL PERMN'X'�EE(Add Lines 2-3 Abovz) �:�r;s'��'.a� : ;� <br /> ."�e�,'3;'r•<'�1�'�,'��ri;k..�rk'tYu?`�:� <br /> ■ " CONfRACT PRICE or JOB COST means the actual oc estimated dollar amount eharged for the <br /> permitted work including materials,labor,profit,and other fi�d costs. It is the amount to be charged <br /> to thc customer for the work done. Xf any rnaterial,equipment,tabor or installations a�furnished by <br /> the owner,tenant or any othcr party,the reasonable market vaiue of such items must be added to the <br /> rstimatui cost or contraet priea for permit fee purposes_ In the event that there is a dispute on the <br /> amount of thc job cost,the City may request the submission of a signed copy of the actual contraet. <br /> ' 1VZECHANICAY,PERMIT`APP�;ICATYQN AGREEMENT..:: ` ::",.�� . <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 Ci nd the regulations of the State of <br /> Minn�sota, and certifies thaC all statements made o ' applicadon are complete, true and <br /> correct. <br /> Applicant's Signature: _�'��;:� �� r/ �� <br /> 3 <br />