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` r ' ' <br /> i <br /> .._. _ _T_. _.__ - . _ ___ .__...., ___._ __.__ , <br /> ���...L�Gr��.� �.t :•�'?i.,'a.�';,e�¢.i���°J�i3}� f <br /> _____��:�'r,���v.�� _��C�C? ��'_.h ait; ��''!$1���__._:_....__._�� �._u i <br /> ❑ Yes,this section appiies <br /> The replacement of a Residential fixture or a�pliance 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;exciudin�the cost of ihe fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Surcharge � 1.00 <br /> Mai!-[n t�ee(If Applicab(e) $^ 2.J0 <br /> Total Permit Fee � <br /> � . . _ . . ,,.. <br /> ��,. <br /> If above does not appiy;follow guidelines be(ow: <br /> 1. CONTRACT PWCE * is 1.25%of contract price with a(Minimum Fee of$5Q.00) <br /> � `�' .S�CJ. �U <br /> /� � _ X.o12s�_ _ <br /> contract pnce) (minimum$50.00) <br /> 2. STATE SURCHARGE <br /> � �i�C V� x.0005 $ ,J� <br /> (contract price) <br /> 3. POSTAGE&HAIviL�LING(Only on Mail-In Applicationsj $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ �,�-SU <br /> ■ * CONTRACT FRICE er JUB CUST means the actual or estimated dollar amount charged fqr the <br /> permitted work including mat�rials, labor,profit,arrd other fixed costs. It is the amount ta be charged <br /> to the customer for the work done. If any material, equip,nent, labor or instaliations are furnished by <br /> the owner,tenant or any other pariy,the reasonable ma.�ket value of such items must be added to th� <br /> estimated cost or contract price for permit 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 /> ,^._..�.� _._.._,_...�.._.__._ .. .,, . . <br /> . , .�- � _ ._ :. .,. <br /> � . � : <br /> ���� �� <br /> The undersigned hereby a�plies to the City for issuance of a Mechanical Permit, agrees to do all <br /> work in strict accordance with the o,rdinances of the City and the regulafrons of the State of <br /> Minnesota, and certifies that all statements made on ihis application are complete, true and <br /> correct. <br /> Applicant's Signature: Date:_ � � <br /> 3 <br />