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11-03-'16 16:20 FROM- T-354 P0006/0007 F-437 <br /> EN M- WE <br /> ❑ Yes,this section applies <br /> The replacement of a Resido ial fixture or appliance that meets all three of the following requirements: <br /> 1. begs not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excluding 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. <br /> State Surcharge $ 5.00 <br /> Mail-In Pee(If Applicable) $ 2.00 <br /> Total Permit Fee S <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE *is 1,25%of contract price wit a(Minimum Ree of$50.00 <br /> �` �'• x.0125$ (03 -7 <br /> t oritmct price) (minimum S50.00) <br /> ?. STATE SCJRC)EIAItC)Eq Q 5 5� <br /> D q t • x.0005 $ <br /> (Contract price) <br /> 3. POSTAGE&HANDLINO(Only on Mail-In Applications) <br /> kL�� <br /> 4. TOTAL PERMIT FELE(Add Lines 1-3 Above) $ <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 party,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 in strict accordance with the ordinances of 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: Date: �>✓r ��� <br /> 3 <br />