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Nov, 5. 2015 8 07A No, 5285 P. 4
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<br /> ❑ Yes,this section applies
<br /> The replacement of a Residential fixture or anoliance that meets all three of the following requirements:
<br /> 1. Does 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 /> Slip 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 S
<br /> If above does not apply;follow guidelines below,
<br /> 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimam Fee of$50.00)
<br /> 2,500.00 x.0125$ Bbl-t6 goo
<br /> (wnuact price) (mirimnm 350"00)
<br /> 2. STATE SURCHARGE
<br /> �P Z,6QC1•C1D X.0005
<br /> $
<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 •2.'5
<br /> ■ " CONTRACT PRICE or JOB COST means the am al 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 Annished 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 Perznit,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 Si ature 009& Date:
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