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Oct, 8. 2015 10: 35AM No. 4994 P, 4/4 <br /> ;,�� pr�;i � �����,1:�����..����'V���� ����i� �����""��w,g�i`9 �'f,� �'� � i'.�� <br /> �'r' ��' �"� 'BASED OFF���OO�:,STATE ST�,.�. ,< ��, -, , , �� , .,�. <br /> ❑ Yes,this section applies <br /> Thc replacament of a Residential fixcw-e or aopliance that meets all thzee of tl�.e�ollowi.ng requirements� <br /> I_ e t require znodi�ication to electrical or gas service_ <br /> 2_ Has a tot c o�$500.00 or less;excludin�the cost of the fixture or appliance:and <br /> 3. Is improve�installod or rcpIaccd by thc homeo�mer or lieensed Coniraetor. <br /> Skip next section,if this applies; Cost of Permit $„ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> ���''�'�'.�.G'lU�..Pi-�`x0�t S �.:�.`7�$�`;C�'��;�'�a0��0'0';;� . ', ';'G„ ' ''�' <br /> If above does not apply;follow guidclincs beIow-: <br /> 1. CONTRACT PRICE *is 1.25%of cantracC price wirh a(lv�iaim�uioa Fee of$50.00) <br /> �z,�oa.00 x.01�5$ 50.00 <br /> (conhact pnce) (mibitutun$50.00) <br /> z. sTA'rE suRcx.�ItGE CMM nr <br /> (�Z,:�IJlJ.4L� x.0005 $ �. !�"J <br /> (coa�ract price) <br /> 3. pOSTAG�,&T-�AN17T,TNG(Only on Mail-Tn Ap�lzcations) $ 2.00 <br /> 4. TOxAX.���'X'T��(Add�.i,nes 1-3 Above) $ CJ�•�•� <br /> • * CON'Z'RACT PRIGE or lOB COST means the actual or estimated dollar amount chargcd for thc <br /> pez�uitted wor�C u�cludiz�g z�aateriais;labor,profit,and other fixed costs_ it is the amount to be charged <br /> to the customer fbr the work done. If any rr�atezial,eqwipnaent,labor or in,srailarions are fumished by <br /> the owne�[,tezzant oz any othez party,the reasoIIable mark.et value of such ite�,s must be addcd to the <br /> eSlxxx�ated cost or co��'act price for permtt fee purposes. In the event that there is a disput� on the <br /> amount of the job cost,the City may zequest the submission of a sig�t�d copy of the actvaI conLtscC. <br /> , <br /> , <br /> ;�' '� ��';AsYJ° ���'°�����.�'�'��"�;�f:�'� '' .�+�- ' '� .'. <br /> �'}ae undersxgaed hereby a��lies to the City far issuance of a Mechanical Permit,agrees to do a11 <br /> work in strict acco�rlance with the ordinances of the City and the regulations of the State of <br /> Minnesot� and certifies rhat a1i sratemcnts rnade on this application are complete, true and <br /> correct. <br /> Applicant's Signature: Date: �(� Q <br /> 3 <br />