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P' 2vC1 "pgt tAtectx,tio*isj, <br /> ... .0 B .SE ,.O 20b2. T�?a STS' l� ua <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;excl udine 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 <br /> I $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Ap licable) $ 2_0Q <br /> Total Permit Fee $ <br /> u'rIktC ',A. rOrr <br /> If above does not apply;follow guidelines below: <br /> I. CONTRACT PRICE *is 1.25%of contract price with a(lil'Ilnimum Fee of$50.00) <br /> 64'-4€1 � .0125$ Jar:?-C <br /> (contract price) (minimum$50.00) <br /> 2. STATE SURCHARGE <br /> Acc90 r x.0005 $ 7 6— <br /> (contract price) <br /> 3. POSTAGE&I-IANDLING(Only on Mail-In Applications) $ 2,00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) 50 <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 doneif any material, equipment, labor or installations are furnished by <br /> the owner,tenant or any other party, the reasonable market value of uch 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 sigted copy of the actual contract. <br /> AP: <br /> M.1(4171 AG:kaa <br /> �,.,.. 5l -'J7 <br /> K, 14gA <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 /> I �Q <br /> Applicant's Signature: id Dae: 6--/g/Z-- /C" <br /> g/�7-/ /C" <br /> i <br /> � I - <br /> 3 <br /> i7/2'd 9ti9b6172:01 1501 W0Nd dbS ZO Sti02lti JFJW <br />