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03-30—' 15 16:58 FROM— T-667 P0003/0007 F-825
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<br /> ❑ Yes,this section applies
<br /> Thc replacement of a}tesidential fxture or ap�fiancc that mtots all Yhree ofthe following rcquirements: ?
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<br /> 1. Docs not require modifieAtion to electrieal or gas service, i
<br /> 2. Has s Cotal eost of$500.00 or less;excluding the cost of the fixture or appliance;and �
<br /> 3, �s improved,installed or replaced by the homeowner or lieensed contractor.
<br /> Skip next seeCion,if tt�is applies; Cost of permit $�� �
<br /> State Surcharge $ 5.00
<br /> Mail-In Fee(If Applic�ble} $ 2,00
<br /> Total Permit Fee �
<br /> �r�,.u"��"�5m�+� , t "'�'�� � ',�. �""' :r, � ,•�--i—,- �
<br /> F ;.��;b��.�������� �?s � ��'�����;t'���i.I��`�IQ��)�:��5;Q���',��,�QO t��, i,,, , ,f ,_,,K;�
<br /> If above does not apply;fvllow guidelines below: �
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<br /> 1. CONTTtACT pRIC� *is 1.25%of contract price with a(Minimum�ee o1'$50.Op)
<br /> ��,��� '�� x,0125$ �
<br /> (contract pricc) ��� 1� � {mtin� �mum�5 .�j`�
<br /> � ����
<br /> 2. STAT�SIJTtCHARGE �.p�'
<br /> ��_x.aoas �1 , `�5
<br /> (contract pr�cc) '
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<br /> 3. POSTAGG&HANnLMG(Only on Mail-In Applications) $ 2.00 �
<br /> `_T 1-' �
<br /> a. TOTAL PERMyT F��(Add�,ines 1-3 Above) g��,�w
<br /> ■ �` COtJTTtACT PRCCE or ]OB COST means the actual or estimated dollar amount charged for thc '
<br /> permitted work induding materials, labor,profit,and other�xed costs. It is the amount to be charged i
<br /> to the customer for the work done. If any material,equipmenC, labor or insiallations are furnished by
<br /> the owner,tenant or any nther party,the rcason�ble market vAlue of such items must be added to the ;
<br /> estimated cost or contract price for pennit fte purposes. In the event tl�ai there is a dispute on the
<br /> amount of the job cost,the Ciry may request the submission of a signed copy af the actual contract.
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<br /> c"y���'�:���`r1�t'ky�«,���''�.9fC��'r�'.#l",��?�t�,�:Y.'��`� ..'.g k�y ?.14�.,1��'�..tei��'�lY�i�.���''.�� �.:),4���`l; 1„�;c vD��<'` �
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<br /> The undersigned hereby applios Co the City for issuAnce of a Mechanieal Permit, agrees to do all �
<br /> work in striet aceordance with the ordinanees of the City and the regulations of the State of �
<br /> Minnesota, and certifies that all statements mad4 on this application are complete, true and r
<br /> con•ect.
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<br /> Applicant's Signature: Date:
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