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11-11—'15 12:16 FROM— T-424 P0006/0010 F-760
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<br /> ❑ Yes,this section flpplies ;
<br /> The repfacement of a Rcsidential fixh,re or appliance that mccts all three ofthe follawing requirements: �
<br /> 1, C7o,�,e��ot requ'rre n►odification to electrical or�as serviee.
<br /> 2. Has a total cosc of$500.00 or less;excludine the cost of ihe�xture or appliance: and •`
<br /> 3. Is improved,installed or replaced b�the homeowner or licenscd contractor, E
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<br /> Skip next section,if this applies; Cost of Permit $ 15.00 i
<br /> State Surchargc $ S�Q i
<br /> Mail-in Fee(IfiApplicable) $ 2.00
<br /> ToCal Ycrmit Fee $ �
<br /> �:, , ,�°�y4 <;�?E;R,MX!'�}�+1.�y�-�(��CAr C�UL>AT�ON '�.IO S �E $SOp,qQ �. ,�, ,.;
<br /> C '—('-/. J ��y .� ��.. ��. r� �
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<br /> If above does not apply;Pollow guidclines below: �
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<br /> L CONTl2ACT P�2TC�: R is 1.25%of contrack pricc with a(Minimum�ce of$SO.UO) �
<br /> �� x".0125,$: ��
<br /> (CO11f�.Ct�Y�Cq)- `�,minimum.$Bp,Oq)' �
<br /> 2. STATE SURCI-�A�2G�, ` � E
<br /> 1��� x';,:000�5;�:�� � �v�
<br /> '.(cbnir�ct prioe)
<br /> 3. POSTAGE&HANDLiNG(Only on Mail-Irt App]ications) ;$! `2 00' ,:
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<br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) ,$ i �-� ',
<br /> ■ ' CQNTftAC'C' PF2YC� or r0�3 COST means the actual or esYimatc�i dollar amount charged for the �
<br /> permittcd work including�nzterials, labor,prof'rt,and oEher fixed costs, It is the amount to be charged
<br /> to the eusTomer for lhe work donc. If any material,equipmen#, labor or installations are fiarnishcd by �
<br /> the owner,tenant or any oiher parry, the rcasonable market value of such rte�ns rnust be added to the ,
<br /> estimated cost or contraet price for pern�it fee purposes. In the event that there is a dispute on t}ie
<br /> amount of the job cost,the City may request the submission of a signed eopy of the actual contract. �
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<br /> > : ::> , :Iv1�CTTANIC��T��Tt7ylx't�A�p�'�Y�AT O A�iREEIvIEN�'��:> „. ' ''., Y `` 's
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<br /> The undcrsigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all �
<br /> work in strict acco��dance with the ordiriances of the Giry and thC ►•e�ulations of the State of f
<br /> Minnesota, and certifies that all statemcnts made on this ap�lication are complete, truc and
<br /> correct.
<br /> G�W►"V W�/�7/ d�F�I/4+{/G I ,. . �` �l � E
<br /> Applicant's Signature: ;D'ate:., +
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