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� F � <br /> _ _ ���1a'I#-#,��Gr.,4.iTt.��.,,rti:1Tn�1,l.,�;�t��17,1�'�'. _ . .,r.; , . � <br /> - - _ . .A����„R��.:LR,� ���l�F����11�:�tk-,.�".if��i;li` - �°`� <br /> ❑ Yes,this scction appli�s <br /> The replacement of a Residential fixture or aaaliance that meets all three of the following requiremencs� <br /> 1. Daes nat require modification to electrical or gas service. <br /> 2. Has a total co�t of$500.00 or less; x� cludi�the cost of the fixture or appliance:and <br /> 3. Ts improved,'rnstalled or replaced by the homeowner or licensed contractor. <br /> Skip next section,if this applies; Cost of Pernnit � 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $� <br /> Total Permit Fee $ <br /> a- � �:s:,��x•-(�::::.< , �9 <br /> _:.... ...__... _. , <br /> ..... . <br /> . <br /> A w! ��r;s�'< �f �;,.,. ,S . y ' '� ', .Ma' � ' r�� ;k . � : �� ...r t�,.2 E1..A`�1,?�`�':��v�,...�.,.T <br /> �+ . ' ' """. : . �� • ��.�.:� . . .. �.. � <br /> If above does not apply;follow guidelines below: <br /> 1. CON RACT PRICE *is 1.25%of contract price with a(Minimum Fee af$50.00) <br /> l,da�.� �.0�25� _�o,r� <br /> (contrect priCe) (minimum 550.00) <br /> 2. STATE SURCHARG� �^ <br /> ��� x.0005 $ � ' �� <br /> (contract pncc) <br /> 3. POSTACr$&T�AND�.ING(pnly on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMYT��E(Add Lines 1-3 Above) $ <br /> ��� �� <br /> � * CONTRACT PRICE or JOB CdST means the actual or estimated doll&r amoul�i charged for the <br /> permitted work including ntaterials, labor,profit,and other fix�d cosCs. Tt is the amount to be charged <br /> Lo the customer for the work done. If any material,equipment, labor or iriStAllations are fumished b� <br /> the owner,tenant or any other party, the reasonable market va4ue of suCh items must b�added to the <br /> estimated cost or contract priCe for permit fee purposes. Cn the event that there is a dispute on the <br /> amount of the job cosc,the City may request the submission of a signed copy of the setual contraet. <br /> �--� <br /> �-,� W ;:�-�'�""' - �': s� ;ft- -�'�'I����'�f'?�tkt:���+�.?V��i�` - <br /> , <br /> . , . <br /> . . <br /> .. . _:.;.�. __ <br /> _.�:�_. .�._� <br /> The undersigned hereby applies to the City for issuanee of a Mechanical Permit; agrees to do all <br /> work in strict accordane� with the ordina�lces of the City and the regulations of the State of <br /> Minnesota, and certifies that all staCements made on this application are complete, true and <br /> correct. <br /> Arrlicant's Signature: <br /> Date- �� �� <br /> 3 <br /> g,�:a6pd 9Z9b6bZZS6Z��l ZbZZSLZeZ� H'�d uos��t,�puaH weg:wo,�� 9Z��ti StiO�-tiZ-B�� <br />