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<br /> � ���d��� �:� t���,��.�,l��+l��C�� i .
<br /> �..�� -: � I .j 11� � 1 ff �i
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<br /> _�.�..::.. �' � �' _ ��+.��t��'��� w:�r�r�� �m��� �m��^t:r� ' , � � ,;,�,;;,i �..;;'`'''
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<br /> � Yes,this section appiies
<br /> l'!�e re��lacement of a Residential �xture or a liance ti�a.t meets all three�f the foflowing 3�equirements:
<br /> 1. Uoes�iot require mod��cation to eiectricai or��s service.
<br /> 2, 1-f as a total cost of$SOOAO oi•less;excludhtg the cost nf the frxhare or appli�nce:and
<br /> 3. Is imprpvetf, installed��r replaced hy the homeowner or licei�serl contractor.
<br /> Skip next section, if this applies; Cost c3f perinit
<br /> �_ 15.00
<br /> St9te St11'chA�,�e � 'S�
<br /> Mail-ln Fee(IfApplicable) $__ 1.�50
<br /> Tofa! Permit Fec �
<br /> j � ° t � � �
<br /> �
<br /> '_�.._.�__ � L�i�!` � ,�' � � �fi;! �+� IC�4 � k:� ' "
<br /> __..__Y.... _, �,�VE+��'�.l`, � � �,, .,,
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<br /> ]f ahnve does not apply;follow guidelines he►n�y;
<br /> 1• CONTRACT PR1C� * is 1.25"/0 of c�ntract price with a(Minimnm Fee of�35.00)
<br /> � (r` , ��j (
<br /> ",!U� � � x .0(25.� �� �/'�
<br /> (con racf pricej - t--�-- --...__.
<br /> (mamim�m R S_0(1)
<br /> ?. STATE SIJRCHARGE **rldd the SI»te Bldg C'ode i�iv. SurcharSe(Minim„m P��of�.50)
<br /> `�`/ 'l i�
<br /> ��� �_�_�_�___---X .onns .
<br /> -r R � � l
<br /> (crnttmcl��ricc! --..__.
<br /> (minimum'$ .SO)
<br /> �. ('OSTnGi�,&.FiAN[)i_.IN(7(OIIIy 011 M91I-II7!��)pI1c;1tIM1S J ,y;
<br /> -- 1:50
<br /> 4. T'nTAt.,PERMiT FTI±:(Add Lines I_3 qh�ve'E �/
<br /> �
<br /> " � CONTR�C'T' PR1CI= ot• .IOB COST mea��s tlte a.ctiial �,r estimated dollar amount cltarged for the
<br /> perinitted work including materials, labor, profit,aizd other fixed costs. It is the emount to he eharged
<br /> t� the ei�stomer for tlie work clone. If�ny material, ec�oip�nent, I���pr rn� j�13t811Rt10119 TP� flll'!]jSl7ecl hy
<br /> the oWper, tenant or any other party,the reasonable market value of such items ntust be added to the
<br /> e,stimflteri cost or c�ntract price f�r �ermit fec �ui�mses, fn the event that thePe iS R dlspute on the
<br /> �maont �1'khe job cost; the City may reque9t tk�e submission of a signeci eopy pf the aetual contract,
<br /> " """The STATE SURCI-I�RGE is.f)OQS of tt�e Iit�ilding Department ar(952)249-4(00 for the price.
<br /> I _.�._ ..__�._.�__.�.__... � ��l�1�=���i. ° "„� : ����'�'���N`�. , .
<br /> + ��
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<br /> Tl�e t�ndersi�ned het�eby a����ties to the City far issuance o1'a. Mechanical Per�nit, agrees to c►o a]I
<br /> ���ork in strict accordance with the ordii�a.nces of the C'i�y and llie regulations of the State �f
<br /> Minnesota, and r,ertifies that all staf.emenf.s made on this application are comptete, true and
<br /> correct.
<br /> �p�lic�nt's Signa.t�at•e;r, �. -- Y �l `_-- - —_.(,�!�/�_ [�ate: b � � p lo
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