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<br /> . ������F.,��.�����«.��fi�.�PERNfI1�F�E.fCAI;C�TL�'A�ION�S)"��"�'�-,� ����,�` �--"}�������;
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<br /> . 7 �~ i£,� *� ,�4r -C .-
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<br /> �`'�' ` _ _- BASED;O�F =2002E,S'rAT;ES`�ATU�� ��:- �' �
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<br /> � �� ':� �: 3 4 / ,r
<br /> .. . � � �' Xt .���5 t{ 1
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<br /> ... . . _ ... . ,�,. , , , ,. . ,. .., .. .b.«"�3#.a.'�".�':��'.k` � . ._R�.{�'R�"'�''x- • .
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<br /> ❑ .Yes,this section applies � - :. , "
<br /> The replacement of a Residential fixture or appliance that meets all three of the following requirements:
<br /> � - 1. : Does not require modification to electrical or gas service.
<br /> 2. Has a total cost of$500.00 or less;excludin�the cost of the fixture or appliance: and
<br /> ` ;3.�,Is improved,installed or replaced by the homeowner or licensed contractor.
<br /> - 4'' � Skip next secrion,if this applies; ' Cost of Pernut , $ 15.00 -
<br /> ` : : r �, � State Surcharge
<br /> : $ .50
<br /> Mail-In Fee(If Applicable) $ 1.50 .
<br /> - Total Permit Fee $
<br /> �`�,�`� '� �EE�ZNIIT,FEE,� s . ,
<br /> ' � �UL-;A�`ION�(�)-�JOB,,S;O,�'ER;�S0.0,'00�..�'��,.��"��.��
<br /> If above does not apply; follow guidelines below:
<br /> � 1. CONTRACT PRICE *is 1.25%of contract price with.a (Minimum Fee of$35.00)
<br /> �'-. ;, _, .-,.;: .
<br /> ��
<br /> ` X.oizs$
<br /> _ (contract price) (minimum$35.00) .,, �
<br /> 2. STATE SiJRCHARGE **Add the State Bldg Code Div.Surcharge (Minirnum Fee of$.50)
<br /> , , '.., x.0005 $ _ (.. �
<br /> (contract price) (minimum 5 .50).
<br /> - 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 1.50
<br /> _ 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ '
<br /> • �' * CONTRACT pRICE or JOB COST means the actual or estimated dollar amount charged for the
<br /> permitted work including materials,labor,profit, and other fixed costs. It is the amount to be charged
<br /> to the customer for the work done. If any material, equipment, labor or installations are furnished by
<br /> the owner, tenant or any other party, the reasonable market value of such items must be added to the
<br /> estimated cost or contract price for pernlit fee purposes. In the event that there is a dispute on the
<br /> amount of the job cost, the City may request the submission of a signed copy of the actual contract:
<br /> � ' **The STATE SURCHARGE is.0005 of the Building Departrnent at(952)249-4600 for the price.
<br /> -:� y 3�'�#� °�MEGHt�.�]ICA�PERIVI[T`.A�PL�TCATIO�AGREEME_T ���,�L: ��*- .
<br /> .�� r _ ��. F -� � ,
<br /> . . .._ � _. . . .. , .. �K�....-�m � ��:�,��.�: '
<br /> The undersigned hereby applies to the City for issuance of a Mechanical Perniit, agrees to do all -
<br /> work in strict accordance with the ordinances of the City and the regulations of the State of �
<br /> Minnesota, and certifies that all statements made on this application are complete, true and
<br /> correct.
<br /> Applicant's Signature: { Date: �=��'� �o
<br /> 3
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