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• -- � F�r-_��Mir H�F c�Lcu��,�r�oN�s��� � � � <br /> � � B�s�.D oFF - 2002 s�rn r� sfr�nTUF <br /> ❑ Yes,this section applies <br /> I'he repl�cement of a Residential f xture or appliance that meets all three oi'the following requirements: <br /> I. Does not cequire modifieation to electrical or yas service. <br /> 2 Has a total cost of$500.00 or fess;excludin�*the c�>st of the tixhn•e or appliance: �nc! <br /> 3. Is improved, installed or re��laced by the homeowner or licensed contractor. <br /> Skip next section, if'this a�plies; (,ost of Perniit $ I_4.0� <br /> St�te Sw�char�e $ <br /> Mail-in Pee(II'i'���plicable) � 1.�� <br /> Total Per�nit Fee � <br /> PERMIT PEE CALCULATION��JI(?BS OVER$�a�:�� ' <br /> �._ --------- ----- �_ <br /> f f above does not apply; f<�Ilo�v guidclines helow: <br /> 1. CONTRACT PRICE * is I.25%of contract price�vith a(Minimum Fee of�35.�)� <br /> ou <br /> � ����. "i_ x .{112� � – �� '�— <br /> (contr�ct��riccl (ininiinum$35 DO) <br /> 2. STATG SURCHARGE ** �the State Bldg�c�e Div. Sarcharge(Minimum�l��e oT�.50) <br /> �� ���, x .0005 $_ �' .� <br /> –—-(contract�xicc) -- – (minimum ti ,�0) <br /> 3. POSTAGE&HANDLING(Only oi�1�1aii-ln Ap��lications) � _ �•5�_ — <br /> 4. TOTAL PERMIT I'EF.(Add I,ines I-3 Above) � ��— <br /> ■ �� CONTRACT PR10E or JOB COS'1' me�ns the actual or estimated dollar amount charged f�r the. <br /> ��ermitted work includin�materials, tabor, protic, and other fixed costs. it is the amount to be charged <br /> to the customer for the��ork done. li'any material, equi��mcnt, labor or installations are furnislled by <br /> the owner, tenant or any other party,the reasonable marl<et value of such items must be aclded to the <br /> estimated cost or contract price for permit fee purposes. In the event that there is a dispute on the <br /> �ul�ount of the jo� cost, the City ma,Y request tiie submission of�a signed copy of the actual contract. <br /> • ��`� The STATE SURCHARGH: is .0005 of the Biiildin�DepartmenC�k(��2)249-4600 for the price. <br /> � MECHANICAL PERMIT �PPL,ICATION AGREF,MENT ____ <br /> T'he undersigned hereby applies to thc City Fo►- issuance c�f�a Mechanical Permit, agrees to do all <br /> w�rk in strict accordance with the ordinances a1� the ('ity and the regulatiot�s of the State of <br /> N1innesota, ai�d certil��es that all statemetlts macle on this application are complete, true and <br /> C.(11'1'�Ct. <br /> (�n � ��te: _�-�-o �__— <br /> nppiicant's Signature: _ �__ 1'�' .1—=- -- ----- <br /> Sf t f UC�sn <br /> 3 <br />