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� 06-01—'16 14:30 FROM— FIRESIDE T-059 P0043/0004 F-548
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<br /> ❑ Yes,this section appties �
<br /> The replacement of a Residential frxture or appliance tliat meets all three of thc following requirements: �
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<br /> l. Does not requi��e modrfication to electrical or g�s scrvice. �
<br /> 2. I�as a total cost of$500.00 or[ess;oxcl�the cost of the fixture or appl;ance:and
<br /> 3. Is improved,installed or replaced by the homeowner or liccnscd contractor.
<br /> Skip next section,if fhis applies; Cost of Permit $ 15.00 �
<br /> State Surchar�e $ 5.�0
<br /> Mail-In Fee(1fApplicable) $ 2.00 '
<br /> Total permit Fee S
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<br /> ;.P.,F��,���r,�,A,�,�'�7��`TI0�1�5 -'rC)�3S(71�;�'$J`"OOr��,� ' :;7,'� rr,`,. ?
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<br /> If above does not apply;follow guidelines below� �
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<br /> 1. CONTRACT PRICE *is 1?5%of eontract price with a(IVlinimum Fee of$50.00) j
<br /> � 7/� �Q 12S$ -���o^���
<br /> (c(1rifF�Gt'(ii't"CZ �(ininimum�s0�o0�
<br /> 2. STATE SIIRCF�ATZC� � �
<br /> � ��� x�0005;.� �. �
<br /> (Fo�i�_�a�) i
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<br /> 3. p�STAG�&HANDLING(Only on MaiC-Cn Applications) $ r2.00.� . ;
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<br /> 4. TdTAL PERMIT FEE(Add�,'rnes 1-3 Abovc) �$ _----��" ':.__ ,�J �
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<br /> ■ * CONTI2ACT PRICH or JOB COST means the actual or estimated dollar amount char�ed far the �
<br /> pertnitted work including matei'iAls,Labor,profit,snd other fixed cosls. Tt is the amount to he ChSrged
<br /> to the customer for the work done. If any material,equipmcnt, labor or installations are furnished by
<br /> the owner,tenant or any other party,the reasonable market value of such items must be added to the
<br /> estimated cost or contract price for �ermit fee purposes. in the event that there is a dispute on the ,
<br /> amount of the job cost,the City may request thc submission of a signed eopy of the actual contraet. i
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<br /> ..: L ,:;� �CHANIGA�;:�'�<�.M�T-A�P�ICt�:TIOI�A��E�MENT,'' , , ;;
<br /> The undersigned hereby applies to the City for issuance of a Mechanical PermiC, 3�rees 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 ail statements made on this application are complete, true and
<br /> correct.
<br /> Applicant's Signature: Date; �r�^ / �CJ
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