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Sp. 30. 2014 12: 59PM JO-NSON CONTROLS INC. 7635855173 No, 4815 P. 3
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<br /> 0 Yes,this section applies
<br /> The replacement of a Residential fixture or appliance 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 Iicensed contractor.
<br /> Skip next section, if this applies; Cost of Permit $ 15,012,
<br /> State Surcharge $_5.00
<br /> Mail-In Fee(If Applicable) 5 2.00
<br /> TotSal Permit Fee $
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<br /> If above does not apply;follow guidelines below
<br /> 1. CC±NTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00)
<br /> 110,000 __ x.0125$ 1375.
<br /> (contract price) (minimum 550.00)
<br /> 2. STATE SURCHARGE
<br /> H 0.0 Pp x-0005 $ 5 5
<br /> (contract price)
<br /> 3. POSTAGE&HANDLING(Only on Mail-1n Applications) $ 2.00
<br /> 4, TOTAL PERMIT FEE(Add Lines 1-3 Above) $ I y 3 g,b 0
<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 arc 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: '----2-7.e.,./2..Z,_--- -7-3-....1(1ate: 9i/�30 / _
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