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, , . <br /> --. -- _ _ _ _._ _.._ _._ _.._ <br /> �}31�,�1� 11�E��[ [ d��y�:l , Ill ���.� I I��r�a��) <br /> � � , ^, � <br /> 7 � � I� � I� <br /> ❑ Yes,this section appli�s <br /> The replacement of a Residential tixture or appliance that meets al]three of the folla�ving requirements: <br /> l. Do�s not reqi.iire modification to electrical or gas service. <br /> 2. Flss a tnt�il cosf of'��00.00 or]ess;excludin�the c�c�st of the fiYture or appli�nce:and <br /> 3. ]s imprin-ed, installed or replaced by the homeo��-ner or licen�ed ccmtractor. <br /> Skip nesC section,if Chis aE�plies; Cost of Permit $ 15.00 <br /> State Surcl�ar�e S SO <br /> N1ail-In Fee(I�f Applic��ble) S 1.50 <br /> Total PermiY Fee $ <br /> ��Rt�IT��� ��,� ����.Tlc��a s� -.roBs o�:ER�soa:ac� <br /> [f�ibovc does not apply; fo�llo��-buide1ines below: <br /> 1. CO�Tl'RACT PRICE *is L2�°��of ci�nt�-act price���ith a(Nliniroum Fee of$35.00} � <br /> �� �j�, G�--'� <br /> _ x .0125$--_;�`�' ---._... <br /> (contract pricch (minimum$3i.00'I <br /> Z. STATF. SURCHAF2GE *'� Add the State�31dg Code Div. Surchar�e(Minimu �F�of��.SO) <br /> �v <br /> ���� x .0005 $ <br /> (cuntractpricej I;minimum$ .50) <br /> 3. PO�"I`AC:�E c� H�INDLING(Only on 1�4ai1-In Applications} S 1.511 <br /> 4. 7'OT;�1_. PER�-1fT FEE(Add Lines I-3 Above) $__`�:�� � <br /> ■ * CONTRACT PR]C1; �»�• .IOB C(JST means the act�ial or estimated dollar amount charg�d for dhe <br /> p�m�iried work including rnatesials, ]�or,protit,and otlter fixed ci�sts. ]t is the an�w�mt to ht char¢�d <br /> to fhe� customer�for the work done. If any mate�rial, equipmeiit, labor or installation� are fi�rnist��ed'by <br /> the o���ner, tenant or any other party, tl�e reasonable market ��alue of suc�h items imust be added to the <br /> estim3led cost or contract �arice for pe,rmit fee purpiises. In Che ever�t that there is a dispute un the <br /> amount ot thc job cost, the City inay request the submissic�n of a signed copy of the achia] contr�;t. <br /> ■ '�*The ST.aTE SURCHARGF,is.0005 of the T3L�ilc�ing DeE�artment at(952)249-4600 for the price. <br /> �r�ex���cAL P���c��r�����r+�.�����������..�: �_ <br /> The undersigned hereby applies to the City for issuance oi'a. I�lechanical Pennit, agrees to do all <br /> work in strict accordance ��-ith the ordinances of the City a:nd tl�e r�c�gulatiu�i7s of the State of <br /> Minnesota, anc� certifies that all statements made� on tt�ris appl�ic��tion are� complete, true and <br /> cc�rrect. <br /> . —�� <br /> Applicant's Sigr�at«re: �--� Date: <br /> R�eset Farrn <br /> 3 <br />