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01-23—'15 15:29 FROM— 1-391 P0003/0007 F-531 <br /> , § 1:te e..0,0tktipt :,) 0 iX '} . IcipV .t:;n Ig 4;.t i,V <br /> � cp; � . �Lio ,�rt., c, i itiF{t-ON ,* ;ifra <br /> MiAY rch#30 $ASU ;a0, ` n rb.. . 4f.a} hg. '' 4 <br /> © Yes,this section applies <br /> The replacement of a Residential fixture ormpliance 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;acjusang 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 /> 11a�ti .&. .010 A. I ^ Flf \ :-? 0. .i '4tY01, <br /> WCNA <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> ( <br /> ‘ (0 x.0125$ LP 6 1l� <br /> (contract price) (minimum 550.00) <br /> 2. STATE SURCHARGE - _ <br /> VV r x.0005 $ _ t <br /> (contract price) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2,21 <br /> 1 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $, 1 t <br /> ■ a CONTRACT PRICE or 1013 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 /> fr, <br /> ,MTJAiki , , .4k;74a01Yt k u'r f+4.N..11 X `,-,0,;,, 13 1...tl"Tt:?itig.ti,:ia!'\aF`tA•k; ,1 <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 /> 64 <br /> 14/1 <br /> Applicant's Signature: Date:w! /20 <br /> 3 <br />