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<br /> ` ❑ Yes,this section applies
<br /> ' The replacement of a Residential fixtute 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 ' 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 Pemut $ 15.00
<br /> State Surcharge $ 5.00
<br /> Mail-In Fee(If Applicable) $ 2.00
<br /> Tota1 Permit Fee $
<br /> _ r �-��T�il����C:�:��`:T,�T:%;�T�+�1'+T � ,-^+;�C�►$�'�1�R�$Sfl�.�I:'__'
<br /> If above does not apply;follow guidelines below:
<br /> 1. CONTItA�T P�C� °is 1.25%of contract price with a(Minimum Fee of 550.00)
<br /> V Ti �V r�V X.�I2.1.D ��i��
<br /> (contract pnce) (minlmum 550.00)
<br /> 2. STATE SURCHARGE '���� �D x.0005 $ ?, ��
<br /> (��Pr►�)
<br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00
<br /> 4. TOTAL PERNIIT FEE(Add Lines 1-3 Above) $ V ✓� V�
<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 fiared costs. It is the amount to be charged
<br /> to the customer for the work done. If any material,equipment,labor or installations are fumished by
<br /> the owner,tena.nt 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 /> Iit���1�1��� ��'.E''•�'�'`LICA�'IQN L�.�RE�1V.�.E�',;."_`;<:_'��,�::�<;'<r�,w=�'v';
<br /> The undersigne�hereby applies to the City for issuai►ce of a Mechanical Permit,agrees to do a11
<br /> work in strict accordance with the ordinances of the City and the regulations of the State of
<br /> Minnesota, and certifies that a11 statements made on this application are complete, true and
<br /> correct.
<br /> Applicant's Signature: ���/'(f'�''�Jx� Date: �"" ��?,
<br /> �"�`�$Sr e•�`������.f ���.r�Y4.n
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