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09-29-'14 16:48 FROM- T-985 P0006/0007 F-090
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<br /> [� Ycs,this sect;on applies g
<br /> The replacement of a�tesidential YrcR�re or apnlitsn�e ihat mccts all Chree ofthe fallowing requirements: �
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<br /> 1, i7oes nnt require modification to clectricsl or gas sarvice, i
<br /> 2. Has a total C�,�of�500.00 or less;exclu�l'�the cost of thc fixture or appliance:and
<br /> 3, �s'rn►proved>installcd or replaeed by the ho�reowncr or lieensed contractor.
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<br /> Skip ncxt seetion,if this applics; Cost of E'ermit $� '
<br /> State Surcharge $ 5A0 '
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<br /> Mail-In�ee(If Applicable) $ 2.00 ;
<br /> TOtA) �'Crmi�Fee $ �
<br /> �`r��r---r—s--� �ca . � �
<br /> ,x`.,,�,'-�'���';'.�I3��`,I���?�1��;��,��Cl�"h1�'T:�`1??I��)����;4 � �: E�'i$:�00 OQ�::,;",�,;�;>y,��«y r,�;
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<br /> Tf above cloes not ap��ly; follow guidel;nes below:
<br /> l. CO1VTTiACT PRIC� '" is 1,25°'0 of conYract price rvith a(iVlinimum�'ee of$50.00)
<br /> � / r � t3
<br /> `�i� x,oizs� ( � (��
<br /> (contract prlce) (minimum�50,00)
<br /> M. STATE SURCHAR(;�� C� (� � � �) �3
<br /> � x.00OS $ / 1 -"'�'
<br /> (conlrac[priCc) �
<br /> 3. nQSTAGE&HANDLING(Only on tvfail-In Applications) $ 2.00 ___
<br /> 4. T4TAl,p��iIv1IT FEE(Add l..ines 1-3 Abovc) � � �� � `"— ,,,_ �
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<br /> ■ * GONTRACT PRIC� or y4B COST means the actua! or estimated dallar amount charged for the ;
<br /> permitted work including materials,labor,profit,and other fixed costs. It is thc amount to be chargcd �
<br /> to Yhe customer for the work done. If any m3terial,equipmeni, labor or'rnstallations are furnished by �
<br /> the owner,tenant w•any other pacty,the reasonable market value of such items must be added to the
<br /> estimated cost or contract price for permit fcc purposes. 7n tl�e event that thcre is a dispute on the E
<br /> amount of the job eost, the Ciry may request the submissian of a signed copy of the aetual contract. �
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<br /> Thc undersigned hereby �ppliCs to the City for issuance of a Mechanical Permit, agrees ca do all
<br /> work in strict accordance with thC ardinflnces of the Ciry and the regulatials of the State of
<br /> Minnesota, and certifies th:�t �11 statements made on this application a,re complete, true and
<br /> correct.
<br /> Applicant's Signature: � �,,, �ate: � C�� �
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