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10-15-' 15 12:17 FROM- T-358 P0003/0047 F-679 <br /> pER1V�TT���CAI�CU�,ATTON�(S) ' � , <br /> BAS�l7�:0��•=.`ZQ02:STAT�.�S"�ATC�E ,. : ` <br /> ❑ Yes,this section applies . <br /> Thq replacement of a Itesidential fixture or applian�,e,thflt rneets all thrce of the toltowing requirements: <br /> 1. Does not roquire modi�cation to electrical or gas se�vice. <br /> 2. Has a toial cost of$540.00 or less; ludin the cost of the fixture or appliance:and <br /> 3, Ts im�roved,installed or roplaced by the homeo�wner or licensed contrACYor. <br /> Skip n�xt section,if this Applres; Cost of Pcrmit $ . �.00 <br /> State 5urchargt $ 5.00 � <br /> Mail-In�'ee(If Applicable) $ 2.00 <br /> TQt�]t'erm'rC Fee $ <br /> �-�wW-P�RIv1TT F��:GA�,C'(Y�,�ITZON(S)�70�5,QUE�$500.00 ' ' <br /> �.��� ��� � <br /> If above does not apply;foliow guitlelines b�low� � <br /> � <br /> 1. CONTI2ACT pY�tYC� � 'rs l.25%of Contract price with a(Minimum�ec of$Sp,l�, ; <br /> �"1 � � � <br /> _—,, V� '� x.01 zs���� <br /> (ConErgGt prlce) (minimum 5B0.0E1) � <br /> 2. S'1'ATE SURCHAIZGE (`� � � � '�_ � � <br /> ....,. �V�f x.0005 $-1�-.�.,_ . <br /> � (conl�ac�prica)� i <br /> 3. POSTAG�&HANbLING(Only on Mail-In Applications) $ Z,p�p- .`�_: <br /> 4, TOTA,�,,r�RMIT FEE(Add Lines I�3 Abovc) $... ���� ! <br /> ■ �" CONTRACT PRIC� or JO}3 CQST means the actual or estimated dollar amount charged for the � <br /> permitted�vork including raatcriais,labor,profit,and other�xed costs. It is thc Amount to be charged <br /> to the customer for the r�vork done. If any matcrial, cquipment, labor or ii�stallations are tiirnished by <br /> thc owner,tenant or any other purcy,the reasonabie market valuc of such items must be added to tht <br /> estimated eost or contract price for permit fee purposes. In the event tl�at there is a dispute on the <br /> amount of the job cost,the City may request tl�e siibmission of a signed copy of the actual contract. � <br /> j <br /> ; <br /> + <br /> MECHANICAL PE�LMYT APPLTGATTpN ACrRE�MENT � <br /> � � __.. <br /> The undersigned hc��cby applics to the City for issuance of a MechAnical Pei•mit,agrees to do all I <br /> work in striCt aCcordance with the ordinances of the City and ihe rCgulations of the Siate of j <br /> Minnesota, and certifies that �tll st�►ternents made on this application Are complete, true and ' <br /> coirect. k <br /> 1 <br /> AppliCanC'S Signature: ���Lf'l/ C..W�"�y� 1]ate:' . l � ! <br /> 3 <br />