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. , 02-10-' 16 15:46 FROM- T-655 P0006/0007 F-039 <br /> � <br /> � <br /> � <br /> E <br /> � �,- --� z _ �'s k'��RyCy�X�'�yP����A��`�.I���.���N('(,�) �� ; Y :� . <br /> i{'v1F�`��1 G 3 'R�y= y` �:Y r.'N�SL�-'\Y�1� J�,YQ���AS�}��'�f,11T��L�Aj /�' � y���.,.�y�- , �r� <br /> ❑ Yes,this section applies <br /> Thc raplacement of a Residential fixture or a plt�_ iance that meets af1 three of the follawing requirements: <br /> 1. Does not rcquire modi�cation to electrical or gas servrce. � <br /> ?. Has a fotal cost of$500.00 or less;excludin fhe cost of the�xture or appliance:and <br /> 3. Is irrlproved,in3talled or replaced by the homeowner or licenscd contractor. � <br /> � <br /> , . r, <br /> Skip next section,if this applies; Cost of permit $ 15.00 ' <br /> State Surchargc $�„ ,�.�0 '� <br /> Mail-Tn Fi;e(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> _-��z ��� - -- - �'=- = = =rr- --���'3�,�-i��3-��������' =�`-'r '-`�--y.�-. _ <br /> - -- -�:_ <br /> r <br /> Tf above does not apply;follow guidelines below; � <br /> 1. CONTRaCT PRrC� * 'rs 1.25%of contract price with a(iVlinimum�ee oY�50,00) y <br /> �7 �0 � x�Aiz�� �d�' . <br /> GO1tttACl pfiCd) (m in imu m 550.00)' <br /> 2. STATE SU►tC�IA�2G� --J ^�,�!_ � <br /> C� !<l�i� X;.000s �_ � �_^_ <br /> connacc prisa) <br /> 3. POSTAGE&HANDL[NG(Only on Mail-ln Applicatians) ',$I_____�69-� <br /> ,��J� �53,3 � : <br /> 4. TOTAL PERMIT FEE(Add Lines L-3 Abovc) $ :+���� <br /> ■ � CONTItACT PRCC� or JpB COST means the actual or estimated dollar amount charged for the <br /> permittcd work including materials,labor, profit,and other fixed costs. lt is the amount to be charged <br /> to the customer for the work done. If any matcrial,cquipment, iabor or installations are Purnished by <br /> the owner,tenant or any other parry,the reasonable markct value of such items �nust be added to the <br /> estimated cost or contraet priee for perm'rt fee purposes. ln the event that there is a dispute on the <br /> amount of the job cost,the Ciry rnay request the submission of a signed copy of thc actual contract. � <br /> _._.__�, , <br /> .� ; _�. � ,� � r�'��� � `� __ <br /> �f--_.� �i��------- ` .-_- -"-,`..-. _ -�-��---�-- .°�'�lf,����'i��+.i;�����-r-__ zs <br /> I <br /> i <br /> � <br /> i <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, a�rees to do all � <br /> work in str'ret accordance with the ordinances of the City and thC rCgulations of the State of <br /> Minnesota, and cerCifies that all statements madc on this application are complete, true and <br /> correct. <br /> Applicant's Signature: ��'+^'V �--�V���'� ;Date: ; � / <br /> 3 <br /> i <br /> � <br />