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48-26—' 14 16:43 FROM— T-879 P0003/4004 F-972 <br /> � ' , <br /> .d ���Y`;'y�� `a � ; � t r <br /> ' �{,�K� a�F }r`k' ���', . . .. k � V nr� . ; F,���,,.( 'E{��y � �,� <br /> � „��`S�i6.�`�.�i�''�:'��f R��..�' . �.:�_4.4�,l°,��.90^�'�i��.. �-. ..��+:'!>! � �k�rv^��, � .t��Fl��+�h�'r�r" 1�.� y <br /> r <br /> ',�.'t.�.,�e�et�nr'` n���tcr �Y'�'.w`i}'b '�' a: 1 vi � s <br /> ❑ Yes,tilis sectiai applies <br /> Ti�e rcplacemcnt of a Resideneial fiixture or appliance that meets all three of Ehe following eeyuirements: � <br /> 1. Does not requira modification to electrical or�as service. ; <br /> 2. �las a total cost of$500.00 or less;excludinz tiie cost of the fixt�re or 2ppliance:and <br /> 3. Ts improved,installed ar replaccd by tho homcowncr or licensed contractor. � <br /> Skip next section,if this applies; Cost of Pennit $ 15_00 � <br /> State Surcharge $ 5.00 <br /> Mai!-In Fcc(If Applic�ble) $ Z.UO ' <br /> , <br /> Tuttil Permit Fee $ <br /> �� <br /> � � , i 1 :` s � � <br /> � �.����T r-� �� � : �;,� ` J.�) ,�� ,�p Q�� � •�: <br /> L����.T��L �. u..M1�... L r�.14�. ' J .�', . �. �T�i• f .A %�.KI � <br /> 1 <br /> 1 <br /> Tf above does not apply;follow guideli�zes below: <br /> i <br /> 1. CONTRACT PRiCE � is 1.25%of contract price with a(1Vlini�num l�ee of$Sp.00) <br /> (�C,,f�.o�Zs$ �U �� <br /> [ICC} {minimum$SO.UO) <br /> 2. STATE SiJRCTCARG� ('� /� (,�j� � � <br /> � �� L � x.0005 $ ` �� � <br /> ( ont�act pricc) � <br /> 3. POSTAG�&T�lAr1T�L�NG(Onty on Mail-Tn Rpplications) $ 2.00� • � <br /> 3� /`� ; <br /> 4, TOTAL PERMIT FEE(Add Lines 1-3 Above) � �.� L � <br /> � <br /> ■ * CONTRAC7' PRTC� or J0� COST mea3�s the acfual or estimatcd dollsr amount charged fot the � <br /> permitted work ineh�din�3naterials, labor,profit, and other fi�ccd c;osts. It is thc amount to bc eharged ! <br /> to the customer for the work donc. If an�+material, equipment, labor or insli311ations are fiimished by <br /> the owncr,tcnant or any other party,the reasonable markei value of such items must be addcd to thc <br /> estimatcd cost or cor�tract price for��ermit fee purposes. In the event that thcre 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 /> " ��`,.:� °�i f .�i� +, ,�•� ' Y� v a �' ,a x � ! -.:;� i <br /> d � <br /> I <br /> The undersigned hcreb� applies to the City for issuanee of a Mechanical Pennit, agrees to do all � <br /> work in strict accordance with the ordinanees qf the City and the regulations of the State of ' <br /> Mint�esota, and cei�t.ifies that al! statements made on this application are complete, tr��e and ' <br /> co�rect. ' <br /> ; <br /> , <br /> � � <br /> Applicant's Signature: ��� � Date: G( � � i <br /> � <br /> 3 ` <br /> i <br />