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41-13-' 16 16:22 FR4M- T-559 P0003/0004 F-930 <br /> { <br /> ! <br /> . , <br /> t <br /> �'�R]y�T�EE C'AT.C�,LA'TION(S} ; <br /> BASEI7�F�-2002 ST'A;'�"k,�'�'AT� : i <br /> i <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixfure or appliance that meets all three of the following requiremcnts� <br /> 1. Does tiot require mqdifiCation to eleCtriCal or gas serviCe. <br /> 2. Has a total cost of$500.00 or Icss;excludin�the cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed conCractor. <br /> Skip next section, if this applies; Cost of Permit $ 15.00 � <br /> State Surcharge $ 5.00 � <br /> Mait-rn Fee(Tf Applicable) $ 2.00 <br /> ' Total Permft Fee $ � <br /> � <br /> ' PBRMI'�'FEE GALCUI,ATIrJN(S),�JOBS OVER$500.00 � <br /> . � <br /> t <br /> If above does not apply;fallow guidelines below: <br /> 1. C01V7'RACT P1tICE � is 1.25%of contract price with�(Minimum�ee of�30.00) <br /> ���� 4� T-FT. / rryr t S}: :��„ <br /> —� Y,�~rr ������r--�-tr�4�.�;J�s 1��kry`:t n�l�e;� <br /> ���,�U �S-�in�jr�ui�1_�i�Q,� <br /> 2. STATE SURCHARGE � � �r' l� �� <br /> –� ��-.�-�, <br /> „— x'�QQ�,�� <br /> � <br /> 3. POSTAQ�8c�TANn�,T1�Cr(Only on Mail-Tn Applications) ��� �'qQ�M�`��";s��� ' <br /> i <br /> 4. TOTAL PERMIT FE�(Adcl T,ines 1-3 Above) �$�����,���xa'.�.�"��..� � <br /> ■ �` CONTRACT P1t�C� or .�0�3 COST means the actual or estiinated dollar amount charged for the t <br /> permitted work including materials,fabor,profit,and other frxed cosis, It is the amount to be ck►argeii ` <br /> to the cuswmer for the work done. If any material,equipme��t, 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 /> astimated cost or contract price for pe�7nit fee purposes, Tn the event tl�at there Is a dispuke ot1 ihe <br /> amount of the job eost,the City mAy requesE the submission of a signed copy of the actual contract. <br /> � <br /> IvIEGHAN'I(>A�C,pT�RTvXZT'A�'P�,YCATION AGR��MEN'T <br /> � <br /> f <br /> The undersigned hereby :�pplies ta the City for issuaizce of a Mechanical Permit, agrees to do all � <br /> work in st.rict accordance with the ordinances of the City and the regu3ations of the State of <br /> Minnesota, and eertifies that all statements made on this application are complete, true and <br /> carrect. <br /> Applicant's Signature: �"'�'v ������ ���`e'��' � I � �� <br /> 3 <br />