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�,�, �,_� , �� . ��;,!� � ' ''-''PE R��]IT I�E�, Gr�_L,C;U LAT[ON(S) ��;�, 3 a�,�;�,� :;� ����,
<br /> '��� ��ii.�ilf}I���f r'�, � � , , , �;:� , _i.'� �li {,,�;,t �''
<br /> :sl�s�i� o�� - Zac�� sT��TE_s�r��vE� . � ,;
<br /> ❑ Yes,this section applies
<br /> The replacement of a Residential fixture or an�liance that maets 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; exchidine the cost of the 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 $ 5.00
<br /> Mail-In Fee(If Applicable) $ 2.00
<br /> Tota!Permit Fee $
<br /> '� +r i:(� � �. � � �,� � ��:" ti� ;u�� ,,,�i ! t
<br /> i,t�a�•.- �� � ,,,�:.:�� �_i.
<br /> If above does not apply;follow guidelines below:
<br /> l. CONTRACT PRICE *is 1.25%of contract price with a(Minimun�Fee of$50.00)
<br /> .�1� , ��; X.ot2s� � �� �
<br /> (conh act price) (mtnimu m$50.00)
<br /> 2. STATE SURCHA.RGE � �
<br /> x,0005 $
<br /> (cont��act price)
<br /> 3. POSTAGE&I-IANDLING(Only on Maii-In Applications) $ 2.00
<br /> 4. TOTAL YERMIT FEE(Add Lines 1-3 Above) $ f�� •�(o
<br /> ■ * CONTRACT PTLICE or JOB COST means the actual or estimated dollar amount charged for the
<br /> permitted work including materi�ls, labor,profit, and other fixed costs. If 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 /> 11ie otvner, tenant or any other party, the reasonable market value of such items must be added to the
<br /> estimated cost ar contract price for permit fee purposes. In the event that there is a dispute on flie
<br /> amount of the job cost, the City may request the snbmission of a signed copy of the actual contract.
<br /> i` '�I''q`;, � �;-n°� ( i: 's�'
<br /> The undersigned hereby applies to 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 complete, t�•ue and
<br /> correct.
<br /> �
<br /> , , 1��1'LC� ���-��� �
<br /> Applicant s Signature. Date; (/ ��)
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