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02-06-'15 14:04 FROM- T-445 P0003/0004 F-586
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<br /> ❑ Yes,this section applies
<br /> The replacement of a Residential fixture or appliance that meets all three of the foilowing requirements;
<br /> 1. Doesp require modification to electrical or gas service.
<br /> 2. Hasa total cost of$500.00 or less;exeludin the cost of the fixture or appliance;and
<br /> 3, Is improved,installed or replaced by the homeowner or licensed contractor.
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<br /> Skip next section,if this applies; Cost of permit $ 15.00
<br /> State Surcharge $ 5.00
<br /> Mail-In pee(if Applicable) $ 2.00
<br /> Total Permit Pee $
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<br /> If above does not apply;follow guidelines below:
<br /> 1, CONTRACT PRICE *is 1.25%of contract price with a(Minimum Pee of$50.00)
<br /> 3.IqQx.0125 S ��'
<br /> "(ccontract price) (minimum 550.00)
<br /> 2. STATE SURCHARGE
<br /> X.0005 $ l~1
<br /> (Contract p(ice)
<br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00
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<br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $
<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.
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<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 regulation$ 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: 2 ly (J
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