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P��.��T�E c�:,eu�.ATlox4s� <br /> BASED OFF- 2Q02 STATE STATUE <br /> ❑ Ycs, this section applies <br /> The replacement of a Residential fixtw�e or a�pliance that meets all three of the following reyuire�nents: <br /> l. Does not require modification to electrical or gas service. <br /> 2. Itas a total cost of$500.00 or less;exdudine the cost of the fixture or a��pliance: 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.p0 <br /> State Surcharge � 5,Op <br /> Mail-In Fee([f Applicable) $ 2.0(1 <br /> Totai Permit Fee $ <br /> PE�'th�I`F FE�+CALGt.J�,ATi(�� � —,{t7�3�OVER$SOU.00 <br /> II abovc docs not apply: lollow guidelines below: <br /> 1. CONTRACT PRICE '" is 1.25°io of contract price with�i (Minimum Fee of$SOAO) <br /> �6�c� � .0�25 � i uo u D <br /> (contract price) (minim�un$�0.001 <br /> ?. STATE SURCHARGE �j h�/� <br /> o�� v a .000s �; <br /> (contrac[ptice) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> �3. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ V v <br /> ■ "' CONTRACT PRICE or JOB COST means thc actual or estimated dollar amount charged for thc <br /> pertnitted work including materials, labor, profit, and othcr fixed costs. It is the amounl to bc chargcd <br /> to lhe customer for lhe work doue. It any material, cquipment, labor or installations are lurnishcd by <br /> the owncr, tcnant or any other parly, the reasonabLe market valuc of such items musl be addeel to the <br /> estimated cost or contract price for perinit fce �urposes. In the evcnt that there is a disputc on the; <br /> amounf ��f the job cost, the City may reyucst the submission of a sig�cd copy of the actu��l contract. <br /> MECHAP3ICAL PE�MIT AP�'LiCATION AGREEMENT <br /> The undersigned hereby applies [o the City for issuance of a Mechanical Permit, 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 con�pLete, true ancl <br /> correct. <br /> l� � �/ <br /> Applicant's Signature: _ �� Date: _ � � 0 __ <br /> ---�.1--__ '_— ---- - <br /> R�set Form <br /> 3 <br />