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43-14-' 16 10:44 FR4M- F I RES I DE T-728 P0403/4004 F-133 <br /> � Lr � �r � �^— , �-- . . <br /> �,,� �F� �2=,, , ;, ��'�����1 F.����AI.�U1,�1'T'Tt�N���), � -`� ; � { _ <br /> �, `s' � ,_J �;�,��,D�()��' �002 �',AT�_��'A�'I1� '' r-_ <br /> ��� -= -- - ,_ - -- � - - <br /> ❑ Yas,t:his section applies <br /> 1'he re�Jacement of a��n�l�xt�ire ar a� li�ance that.meets all three of the fallowing requiremcnts: • <br /> 1. Does noi require n-�odif�cation Co electrical or gas scrvice. <br /> 2. l-Ias a total cost of$SUU.UU or less;cxcludin�the cost of the fixture or appliance:and i <br /> 3. 1s improved,installed or replaced by the homeowner or licensed contractor. <br /> Skip next section,if this applies; Cost of Permit $ 1 S QO <br /> State SurcN�arge $ 5.00 <br /> Mail�In Fee(If Applicablt) $ 2.00 <br /> To{al permit�ee $ <br /> •�a�c .c. y y ]^.�s�"j( i <br /> �'�'�r C+r � �J����-=. ��..���^S�rV!�"���'�=�� � <br /> [��.::�--,�,������:��� ����.�' �V( �..�- Y W <br /> � <br /> Yf above does not apply;follow guidelines below: � <br /> 1. CONTRACT PRIC� �is 1.25%of contract price with a(Mir►imum�ee of$SO.UO) i <br /> .5' � <br /> 52�..� �,��ZS� �� , <br /> (can�ract pricc) (minimum�50.40): <br /> 2. STATE� SURCHARCrE C`��(,/���` �;;ODOS.�'$. �,�� <br /> I � <br /> v ! <br /> (Cont«ct.price). p <br /> 3. POSTAGE&HANDLINCr(Only on Mail-In Applications) �$,' .� ` <br /> 4. T'OTAL PERMIT FEE(Add�,ines 1-3 AUovc) ���,�_' , ; <br /> ■ " COi�T}2AC"1' P�tICE or JOB COST means the actua) or estimated do3lar amount charged f'or the � <br /> permitted wark inch�ding materimis, labor, pr'ofit, and other fixed costs. 1t is the amount to be eharged <br /> to th�customer for the work done. If any matcrial, cquipment,labor or installations are fUrnished by <br /> the owner, tenant or any other party,th�reasonable market vAlu�of such items must be added to the , <br /> eStimAted cost or Contract price for permit fee purposes. Yn the event that tlierc is a dispute on the ` <br /> amount of the job cost, thc City ma� re9uest the submission of a signed copy of the �etual eon[raet, j <br /> � <br /> i <br /> �-�,:�4. :� .-_��,�__� =- .�L��.��aTr��x�N�=������1 � <br /> c r-- ��� �.-- —— � <br /> i <br /> The undersigned hereby ap�lies to the City for issuance of a Mechanical Permit, agrees to do all <br /> 'work in strict accordfince with the ordinances of the City and the regulations of the State of <br /> Minnesota, and cer[ifies that all st:�tements macle on this application nre complete, true and <br /> correct. <br /> Applicant's Signature� ���'�^"v ���y�i�'Y` Date: ' v (� <br /> 3 <br /> � <br /> � <br />