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11-29-'17 14:03 FROM- T-210 P0006/0007 F-605 <br /> .rR'tt�`,`�Sl�,l��•�����`!'"w� •.�J,°. t'C' tA <br /> ;' +• y'v. ',� •4����2 y�( 2 <br /> A <br /> ' .�! :✓r'•amr.�1. .' ":i .'lam ..0 fNt:. ;;•i[c?:..5'0. <br /> ❑ Yes,this section applies <br /> -- --------" —'The-replaoement-of trResidential fixtuWdriapliance-that meets,all-threerofthe-followingrequirzments:........ <br /> -'"':_.______.............. <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Hasa total cost of$500.00 or less;excludinrY the cost of the fixture or appliance:and <br /> 3. Is improved,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 /> - r/� <br /> '0. 'r F .}+►;i{�.:a b l?� !N' �?� +.Zfik bw .r�44�', . <br /> .._1... t '�n.h ..[ <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE a is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> 1,7557 <br /> 2. STATE SVRCFfA)RGE Q (0 17 <br /> x . <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) � <br /> ir7 <br /> 4. TOTAL PERNff FEE(Add Lines 1-3 Above) � a` <br /> CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the <br /> permitted work including materials,labor,profit,and other fixed costs. 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 parry,the reasonable market value of such items must be added to the <br /> estimated cost or contract price for permit 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 /> The undersigned hereby applies to the City for issuance of a Mechanical Permit,agrees to do all <br /> work to strict acco ance vfith the ordinances ot Me City and tile regulations of the State o <br /> Minnesota, and certifies that all statements m e or► application are complete, true and <br /> correct. <br /> Applicant's Signature: <br /> 3 <br /> 4 <br />