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<br /> ❑ 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 licensed contractor.
<br /> Skip next section,if this applies; Cost of Permit $ 15.00
<br /> State Surcharge $ .50
<br /> Mail-In Fee(If Applicable) $ 1.50
<br /> Total Permit Fee $
<br /> If above does not apply; follow guidelines below:
<br /> 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$35.00)
<br /> Sci764- x.0125$ 6
<br /> (contract price) (minimum$35.00)
<br /> 2. STATE SURCHARGE **Add the State Bldg Code Div. Surcharge(Minimum Fee of$.50)
<br /> 30
<br /> Sy764 x .0005 $ Z•
<br /> (contract price) (minimum$ .50)
<br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 1.50
<br /> 9'
<br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ 7"
<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 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 STATE SURCHARGE is .0005 of the Building Department at(952)249-4600 for the price.
<br /> pa„ . .rte a efV iL m;1:! y t t. i .: w 0oxs : ..u" ,n 1'rl 7 M
<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: iFg£S Date: Z//zw-ef
<br /> 3
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