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, ' P��ti-i��r ��� C,�L�'U�,�ZtO�ts) <br /> ���'� �� a,����v o��� -�r�������TAT� s�r�a��L�� � � � <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fiature or appliance that meets all three of the following requirements: <br /> I. Does not require modification to electrical or gas service. <br /> 2. Has a total cost oY$�00.00 or less;excludin�the cost of the fixture or appliance: and <br /> 3. Is improved,installed or replaced by the homeowner or licensed conVactor. <br /> Skip ne.r-t section,if this applies; Cost of Yermit $ 15.00 <br /> State Surcharge $ SO <br /> Mail-In Fee(If Applicable) $ 1.50 <br /> Total Permit Fee $ <br /> : I�E�#.I'�IT�E�C���Lzak'FIf��T� -.TOB�'(���R��00:� <br /> If above does not apply,follow guidelines below: <br /> 1. CO1VT'RACT PRICE ' is 125%of c�ntract price�tiith a(Minimum Fee of$35.00) <br /> ��S <br /> �1 x.o12s$ �� = <br /> contract price) (minimum$35.00) <br /> 2. STATE SURCHARGE •x Add the State Bldg Code Div. Surcharge(M;nimun►Fcc of 5.50) <br /> � �� x.0005 $ �- �� <br /> ' (c ntract price) (minimum� .�0) <br /> 3. POSTAGE 8i HANDLING(Only on Mail-In Applications) $ 1.50 <br /> � <br /> �. TOTAL PERMIT FEE(Add L,ines 1-3 Above) ���� <br /> ■ * CONTRACT PI210E or JOB COST means the achaal or estimated dollar amotu►t charged for the <br /> pennitted�rork including materials, labor,profit,and other fised 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 patty,the reasonable market value of such items must be added to the <br /> estimated cost or contract price for pecmit fee purposes. In the event that there is a dispute on the <br /> amount of the job cost, the Citv may request the submission�f a signed copy of the actual contract. <br /> ■ '"*The STATE SiJRCHARGE is.(x1U5 of the}3uildnlg Depart�nent at(9�21?49-�fi00 for the price. <br /> ��Ck�I�I�C��E��IIT t�'PI�ICI�TI�}N.'ACr�E�MEI�' <br /> The undersigned hereb_y applies to the City for issuance of a Mechanical Permit, agrees to do all <br /> ��ark in strict accordance with the ardinances of the Cit� and the regulations of the State of <br /> Minnesota_ and ccrtifies that all statemcnts madc on this application are complete, truc and <br /> correct. <br /> Applicant's Signature: � Date:������ � <br /> _ <br /> _.. _ <br /> Reset Forrt� <br /> 3 <br />