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02-25-'15 10:21 FROM- T-539 POOQ3/0004 F-686
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<br /> ❑ Yes,this section applies
<br /> The replacement af a�tesidential fixture or ap lit� anc�that meets all threc of the followin�requirements:
<br /> L Docs not require rnodif,cation to electrica!or g�s service.
<br /> M. 1�as a total c�of$SOU.OU or less;excludin tt;e cost of the fixture or appliance:and
<br /> 3. Is improved,inskallcd or replaced hy che hameowner or licensed cantractar.
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<br /> Skip next section,if this applies; Cost of Permit $ 15.00 �
<br /> State Surchar�e �,,.„�,_,�,�Q,Q '
<br /> Mail-Tn Pee(If Applicablc) $�2.00
<br /> Tofal Permit�ee $
<br /> �� 1>.:'� ,�,`.,:�;�' ����tr���,�s���4�.�ATrOr�(S)r°��������'�S:oU.�o:�;.� 4 ,�''� �1
<br /> ]f abovC doas not apply;follow guidciincs belo�r �
<br /> I. CQNTRACT PTtTCE * is !.?5%of contract price with a(Minimum Fee of$50.00�
<br /> '^"� f�� x.0125$ �� �
<br /> ��(canir3ct price) � (minimum$50.00)
<br /> z. sra�r�s�r�c�a�c�; �..�'���j ,�.000s $ �, ���
<br /> � (ContrBct pricc) `
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<br /> 3. POSTAGE&HANDLING(Onl�on Mail-In AppliCations) $ 2.00 �
<br /> 4. 7'OTAY,P�RMCT�'��{Add Lincs 1-3 Above) $ �l/ �� �� �
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<br /> ■ "' GONTRACT PRIC� or .IOB COST means the actual or estimated dollar amount charged for the I
<br /> pe3�mitted work including materials, labor,profit,and other fix�d costs, lt is tfae amount to be char,�ed �
<br /> to the customer for the work done. If any material, equipment, l�bor or installations are furnished by �
<br /> ihe owner,tenant or any other parry,the reasonable market value of such items must be added to the �
<br /> estimated cost or contract priee for permit fee purposes. In the event that there is � dispute on the j
<br /> amount of the job cost, the City may request the suUmission of a signed copy of the actual contraet. f
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<br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all �
<br /> work in strict �ccordance with the ordina��ces of the City and the regulations of the State of
<br /> Minnesota, and certifies that a11 statements ITIAdZ on th'rs applic�tion are cornplete, YruC and
<br /> CO3TCC�,
<br /> Applicank's Signature: ����� , Date: G--%�// �
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