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02-19—'15 14:07 FROM— T-510 P0003/0004 F-657 <br /> 10 yi GJ" 4ldri i� 1`�.,r• ..`.• i Ey A ) I t♦ ��prc+® `q\ <br /> b ''11��''(. �tl� '.fr/ x1 G' wl+. " 1j,'.4 '.1 •' ��, Q �, {�.pli ti..f <br /> / J �' �ryT 1 � i z, � rtl ,� r .t air a c K (, i. r ViiCCC••r�l { ik::F � ifs.. <br /> A 4C� � < acv ' y 'jf� • gN ' + <br /> � 1 �r • ,;t:2 yZ,I, `P9' A <br /> 0 Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requirements: <br /> I. 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 /> 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 /> t <br /> l*M12 4N . .'<?p. <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE *is 1.25%of contractprice with a(Minimum Fee of$50.00) <br /> "1/7 x.0125 $ ,c2. /7 <br /> (contract price) (minimum 550.00) <br /> 2. STATE SURCHARGE _ 1/7 f x.0005 $ t 0 <br /> (contract price) <br /> 3. POSTAGE 84 HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 574,2"-ei <br /> $ <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) <br /> * CONTRACT PRICE or SOB 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: 411111011111Date: <br /> 3 <br />