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Nov, 19. 2015 11 ; 17AM No, �337 P, 2
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<br /> ❑ Yes,this section applies
<br /> 7he replacement of a esidential fixture or a ce that meets all three of the following requirements�
<br /> 1. Does�zequire modification to electrica!or gas service,
<br /> 2. Has a t ta co t of�500.00 or less; e c ud' the eost of the fxture or appliance:and
<br /> 3. Is improved,installed or replaced by the hom�owner or licensed contraetor.
<br /> Skip next section, if this applies; Cost vf Permit $ 15.00
<br /> State Surcharge � 1.00
<br /> Mail-Tn Fee(If Applicab�e) $ 2.00
<br /> Total Permit Fee �
<br /> , �'
<br /> r�ik; � , �, � 5 ' ,
<br /> � "` ��� �'�L���,�.;�.'��,�'T�I�T �';''���t�I�� �QVEI�";� b'.,�� ,�!'�"� '"���� �,r�. ; ,, , ,;;
<br /> If above does not apply; follow guidelines below:
<br /> 1. CONTRA.CT PRICE " is I.ZS%of contract price witl�a(Minimum�'ee af$50.0�)
<br /> �3�c.o X.oiz5 � �`I . G S
<br /> (contract pricc) (mie;mum 550.00)
<br /> 2. STATE SURCHARGE +
<br /> � � o��-P x ,0005 $ � - � `P
<br /> (contract p[icc)
<br /> 3. POS�AGE&HANDLING(Only on 1VZai1-Z�Applications) $ 2.9Q
<br /> 4, �'QTAI�PERMIT FEE(Add Lines 1-3 Above) � �•�—L—
<br /> ■ * CONTRACT 1'RICE or JOB COST means the actual or estimated dollar amount cl�arged for the
<br /> permitted work including materials,labor,profit,and other fixed costs. It is the amount to be charged
<br /> ro the customer for the work done. If any material, equipment, laUor or installations are fumished by
<br /> thc owner, tenant or any other party, tl�e reasonable market value of such items must be added to the
<br /> estimated cost or contract price for permit fee purpos�s. In the event that there is a daspute on the
<br /> amount of the job cost, the Ciry may requcst thc submission of a signed copy of the actuat contract.
<br /> �;�, � �j��'�� �� '�ii�`'����������' '����',.�i��?L' r('�I/� �I�':�I�' '; E ` , ', � , °���1�4 ,� � ,.:
<br /> � G'�>, � ��i'�!,�.I � 1. � I'otr"�'Y� ���' �� ,�I�II ai I o���.I� � .i�;
<br /> ,: � i... , , .. . ..,. .. . .... ...-
<br /> The undersigned hereby applies to the City for issuance of a Mechanical Pernait, agrees to do all
<br /> work 1n st�lct aecorda�lce with the ordinances of the City atld t�le regulations of the State of
<br /> Minnesota, and certifres that all statezx-ients t�nade on this application are complete, true and
<br /> coiz-ect.
<br /> Applicant's Signature:!i��g� � Date: I I ^ � Ir� �
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