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. . , • <br /> �����'�EL ��LCU�.4TION(Sl <br /> �Q�z ������������ ❑ Yes "I"his Section��plies <br /> The replacen7ent of a Residential fixture or appliance that meets aIl three of'the followinb requirements: <br /> 1) Does not require modification to electrical or gas service. <br /> 2) Has a total cost of$500.00 or less; excludin�the cost of the fixture or appliance_ <br /> and <br /> 3) Is improved, installed or replaced by the homeowner or licensed contractor. <br /> Skip ne�t section; Cost of Pennit $ 15.00 <br /> State Surcharge $ ,�p <br /> Mail-In Fee $ 1.50 <br /> If above does not apply, follow guidelines below; <br /> 1. �'ea�a�a-�ct F��-i�e* is .0125% of job with a ll�Ena��a����arrs �ic�e��'(��� �0) <br /> --`��6�--c.�____x .012 5 $ .� . �� <br /> (contract price) (minimuit��35.00) <br /> 2• ����� ���'�:��ar�e. ** A.dd the State Building Code Division a I�a'�in�r�a�rn �ee�f'(g; 50) <br /> ����. '� x .0005 � �,�� <br /> (contract price) (minimum� .50) <br /> 3. PQs�a�e asad �-Iandien r (�jzl�}��aa�ril-t�r c�p�lieatia�rs} $ �5�-- <br /> - `-o-; <br /> 4. �'�'�'AL �'��21l�I�'��� (Add lines 1-3 above) � ���� <br /> *CO?JTRACT PRICE or JOB C05T means the acCual or estimated dallar amount charged for the permitied v,�orlc including <br /> materials,]abor,profit,and otl�er fixed costs. It is thc amoui�t to tic chargcd to the customer;or the work done. If any matenal, <br /> equiPr�ient, labor,nr installation is furnished by the owner,ta�ant or any other party the reasonable market value of such items <br /> must be added to the estimated cost or contract price for permit fee purposes. In the event that there is a dispute on the amount of <br /> thejob cost,the City may requesC the submission of a signed copy of the;:ictual contract. � <br /> **'The STATE SURCHARGE is.0005 of the contract pricc under$1,000,000 or$.50-whichever is greater. Por valuations over <br /> �1,000,00U calI the Department of Ir.spectional Sen-ices for the price. <br /> The undersigned hereby appties to the City for issuance of a ivtechanical Pern�it,agrees to do al]u�ork in strict accordance with <br /> the ordinailces of che City and the regula ' s of the Minncsota State t�uilding Code,and certi6es that al]statements made on tllis <br /> application are complete,true and corr <br /> � <br /> lipplicant's Signature: � �:-' "�� --_ �,,��`.� Date: � <br /> _ � �� <br /> Approved By: Date: <br /> 3 : <br />