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11-03—'15 09:14 FROM— T-395 P0003/0004 F-728
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<br /> ❑ Yes,this section applies
<br /> The replacement of a Residential fixture or ggl2liance that meets all three of the following requirements: i
<br /> i
<br /> 1. Does Qg require modification to electrical or gas service.
<br /> 2. Has a total cost of$500.00 or less;mdja ft 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 Pee Of Applicable) $ 2.00
<br /> Total Permit Pee $
<br /> ',>"Y
<br /> If above does not apply;follow guidelines below: _
<br /> i
<br /> 1, CONTRACT PRICE *is 1.25%of contract price with a(Minimum Pee of$50.00)
<br /> `x;0125$'
<br /> C.nitao2 price (miniingai$500);
<br /> 2. STATE SURCHARGE
<br /> x x.0005
<br /> `contraFi pdca)'
<br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) ;$;-- 2.00:.'`s.'
<br /> 4. TOTAL PERMIT PEE(Add Lines 1-3 Above) f$;i::`%! (
<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.
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<br /> 7:✓ •NVi;>L::rP.'�' ''_ s� :'•Y'C'..1..�.+ O ,E .C1:)..REBMLN
<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: l.,rtr�ef't'�te-Ge�' ;Date:: V
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