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�>��I�n���;�E� c�a11cUL��TIo���s� <br /> � �� � � � ��� � �B�SFD f)FF�- 2002 ST�1TE�STf�TU� � <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requirements: <br /> l. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excluding the cost of the fixture or appliance: and <br /> 3. Is improved, installed or replaced by the homeowner or licensed contractor. <br /> Skip next section, if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ 1.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> .;,�� P ��iTT'FF'F � %' ^.' �- �- <br /> ER� �� �, <br /> , <br /> � <br /> , - <br /> � _ _ � , < : �, .... ,s ` .� <br /> y <br /> " .- ; <br /> - - , -< . . .,.. .... ., .r.... , <br /> '`G2r.r.,, . '., . - ' <br /> If above does not apply, follow guidelines below: <br /> 1. CONTRACT PRICE * is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> Stzp � x .0125 $ � � <br /> (contract price) (minimum$50.00) <br /> 2. STATE SURCHARGE <br /> St�o w x .0005 $ o� � <br /> (contract price) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> sv <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ � <br /> ■ * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the <br /> permitted work including materials, labor,profit, and other fixed costs. It is the amount to be charged <br /> to the customer for the work done. If any material, equipment, 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 /> estimated cost or contract price for permit fee purposes. In the event that there is a dispute on the <br /> amount of the job cost, the City may request the submission of a signed copy of the actual contract. <br /> �, � � �� ,� <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all <br /> work in strict accordance with the ordinances of the City and the regulations of the State of <br /> Minnesota, and certifies that all statements made on this application are complete, true and <br /> correct. <br /> Applicant's Signature: �� Date: /�7/� <br /> � <br /> 3 <br /> � � <br /> , <br />