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4 c�y a .e 4, i s x r a a-�+ �'' i4' ' S a ,y,�� '� 1 a i'r <br /> .� �3 Y �{,'w+ �� 1. F f 34 p �9 A�4� A� R� s �'2 � 'R- C f. <br /> 'I ,,, N i I p 7 w #$ 'k. - Sao-+ N .,A "w h' l .ri. o o t }. <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$35.00) <br /> Aft- x.0125$ 3b ' bp <br /> (contract price) (minimum$35.00) <br /> 2. STATE SURCHARGE **Add the State Bldg Code Div. Surcharge(Minimum Fee of$.50) <br /> gD - x.0005 $ /- 4o <br /> (contract price) (minimum$ .50) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ 6te 40 <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 SURCHARGEpis.0005 of the Building Department at(952)249-4600 for the price. <br /> 'a Elle t 1 1 Pu S &y, � .,:� °R� 1 Al ,,1 ,,.-',.-'..w,==:, <br /> r <br /> K_� „ 'a.-,.�.5 ,Y,.J 7..,a. r .w„ ...,. $. . . ,.,..r , n ,rY,. ,.�,a�,.+,e 'L . ... <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: Date: (9-8-N, <br /> I <br /> Reset Form <br /> 3 <br />