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05/27/2015 10:29 6127246656 TEAMMECHANICALINC PAGE 04 <br /> ❑ yes,this section applies <br /> The replacement of a Roidential fi e or aDDliAnce that meets all three of the following requirements: <br /> 1, Qoes not require modification to electrical or gas service. <br /> 2. Hasa 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 $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE *is 1.251/o of contract price with a(Minimum Fee of$50.00) <br /> 41-9A9 x.0125$ �ti 1� <br /> (contract price) (minimum$50.00) <br /> 2. STATE SURCHARGE <br /> X.0005 $ <br /> (contract price) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ <br /> S� <br /> 4, TOTAL PERMIT FEE(Add Lines 1-3 Above) $ A29 <br /> ■ * CONTRACT PRICE or .FOB 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: bate. _6�0VA� <br /> 3 <br />