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��'���� ���' ������..�5.����7{��} <br /> 200� S�ate Statutc: ❑ �i'es 'This Se�gi�aa�ppiie� <br /> ihe replacement of a�esidential fixture or appliance that meets all three of the following requireinents: <br /> ]) Does not require modification to electrical or gas service. <br /> 2) Has a total cost of.�',�00.00 or less; excludin�; the cost of the fixture or appliance: <br /> and <br /> 3) Is improved, installed or replaced by the hameow�:er or licensed contractor. <br /> Skip next section; Cost of Pennit $ 15.00 <br /> State Surcharge $ .50 <br /> �ail-In Fee � L50 <br /> If abo��e does not apply, follo����uidelines below: <br /> �. ��an����� �'�-e�c* zs .0125°io of job v��itl7 a i��r.A��n��trn �;ec �f�S�?5.00) <br /> _1�C� �-� x .0125 � ��• � <br /> (contract price) (minin�uin 535.00) <br /> 2. �tate �urehar�e. ** Add tl�e State�3uilding Code I�ivision a li�i:aimum �'ec of(� .�Q} <br /> I (CX�•�� s .0005 � tSS <br /> (coniract price) (minimum� .>0) � <br /> 3. 1'asf�aQe ar�c��aa�c��izi� (�ral��r�arcil-%ra ap�licatit��r�s� S,,' ;�� <br /> 4. '�'��'�,�, ��������' ��'� (Add ]ines 1-? above) � 7j`7 � s� <br /> *C`OI�TRACT PRICF�or JO�COST means tl;e actual or tsCimated dollar ar,lount chars,cd for the permi±ted��orl:ineiudirig <br /> materials,labor,protit,and otller fixed costs. It is tl�e a�nount�to be charged Co the customer for the work cione. If�ny n�aterial, <br /> equipnient,labor,or inst�ailaCion is furnisNied by the owner,tenant or any other parry the reasona�le market��alue of'such itcros <br /> must be added to the eseimated cost or contract price for permit fee purposes. In the ever,t that there is a dis�ute on th� arnount of <br /> the job cc�st,the City may rec�uest the suomission oi a signed co�y of ihe actual co:itract. <br /> *� The STAT�SURC]-IAI?GG is.0005 of the contract price under�1,00U,000 or�.50-whichevcr is greater. For valuations over <br /> �1,000,000 call th�Depar[ment oi In�pectional Scrvices for the price. <br /> The undersigned hereby applies to the City for issuance of a Mechanical Pennit,agrees to do all worlc in strict accordancc��-ith <br /> thc ordinances of the City and the re�ulations of the �innesota State L'uildin;Code,and certiGes[hat all statements made on lhis <br /> application are complete,true d correct. <br /> Applicant`s Sibiature: `J�l!`�S�VL.J�� ` �,,t� � � ,��-- <br /> Date: �— ���7 <br /> Approved By: Date: <br /> 3 I <br />