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06-08—'16 13:22 FROM— F I RES I DE T-131 P0�43/0004 F-623
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<br /> ❑ Yes,this seetion applies
<br /> The replacement of a Resident[al fixture or apptiance that meets all three of the following requirements:
<br /> 1, boes not require modifieation t4 nlcctr►cal or gas service. �
<br /> 2. �Cas a totat cost of$500.00 or less;excludinQ the cost of the fixtuca or appliance:and
<br /> 3. Ts improved,installed or replaced by the homeowner or licensed contractor.
<br /> Skip next seotion,if this applies; Cost of permit $ 15.00
<br /> State Sureharge � 5.00
<br /> fvlail-In Pee(Cf Appl�cable) � 2.00
<br /> Total Permic�'ee 5�, ,
<br /> _ .r _-�{�..���. /-� .. i �iy'� (�
<br /> ..�1..5'Y,�����?' �h.S.!? �.2e?� � ����,A�_�: �'"�. .6�����+G,_ �.kC �-�S�ss`�,.Nc�`� :,.i'?.,. i
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<br /> Tf above does not appt�+;foliow guidelines below: �
<br /> f. CONTRACT p�tYC� *is 1.25%of contract price with a(Minitt�um�ee aP�50.00) �
<br /> 7S o�
<br /> 3 5(�O. (X o�2s$ � �� ,�
<br /> �ontract priCy (minimum S50 00))
<br /> 2. STATE SURCI-EACtG� ��r��, "7� �/
<br /> �,� � x.0005 $
<br /> �P �
<br /> �`contract rir,� ------.--
<br /> �s,.... ..---�._�-
<br /> 3, pOSTACr�8c�CAI�'T�LiNG(Only on Mail-In A�plicat�ons) r$ �00
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<br /> 4. T�TAL PERMIT F�E(Add Lines 1-3 Above) � _ �
<br /> • r CONTRACT pTtCC� or r0� COST means the actual or estimated dollar amount chargcd for the
<br /> permitted work including materials,labor,profit,and other fixed costs. Tt is the amount to be charged
<br /> ro the customer for the work done. If any material,equipment, labor or installations are furnished b� '
<br /> tlie 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 permit fee pur�oses. In the event that there is a dispute on the j
<br /> amounc of ehe job cost, the Ciry rnay request the submission of a signed copy of the actual contract. E
<br /> .. _. _. . ... _. .._. . . . ._. .. .._ ... ,
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<br /> ,r�.�.�i t i .G '-�,i_.�7.
<br /> The undersigned hereby applies to the City for issuance of� Mechanical Pe�mit, agrees to do all
<br /> work in strict accordance �vith the ordinances of the City and the regulations of the State of
<br /> Minnesota, and certifies that ali statements made on this application are complete, true and
<br /> cori•ect.
<br /> ���- � _. ��8-l�
<br /> Applicant s S�gnature: �_atc_
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