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� w <br /> •� � <br /> ���1� ��� ��Lc.�rL��r����s� <br /> 2002 State Statute ❑ Yes This Sec�ion r�,�piaes <br /> The replacement af a Residential fixture or appliance that meets all three of the following requireinents: <br /> 1) Does not require modification to elech�ica] or gas service. <br /> 2) Has a total cost of��00.00 or less; excludin�the cost of the fixture or appliance: <br /> and <br /> 3) Is improved, installed or replaced by the homeowner or Iicensed contractor. <br /> Skip next section; Cost of Permit $ 1�.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee $ 1.�0 <br /> If above does not apply, follow guidelines belew: <br /> �� �'�r��;�•��4 �'�-i�e* is .0125°io of joo�-ii:11 a 1,�Fa�o�g�arn �+e,� o���?5.00) <br /> ���-'.� x .0125 � ���� <br /> (contract price) (minimum 535.00) <br /> 2. St�te �e�regz�ro�. ** Add the State Building Code Division a�'�ir��rnum �'ee o$��S; .50} <br /> ����•�� x .0005 $ / �� <br /> (contract price) (minimum$ .50) <br /> 3. �'�asga�,=e ar�d ���ndlir� (P�ti11�raaai!-irr t�ppZieatiora�s) � �� <br /> �� �'���� ���✓t�'�' ��� (Add lines 1-3 above) � �oZ �v <br /> * CO��TRACT PRICE or.IOB COST means the actual or estimated dollar amount charged for the pernlitted wurk includin; <br /> n�aterials,la�or,proftt,and other fixed costs. It is the amount to bc charged to thc customer for the work done. If�ny material, <br /> equipmcnt, labor,or installation is furnisncd by thc owncr,tcnant or any other party the reasonable market value of sucti items <br /> must be added to the estimated cost or conuact price for permit fee purposes. In the event that there is a disput�on the amount of <br /> thejob cost,the Ci±y may rcquest the submission ot a si�ned copy of the actual contract. <br /> � **The STAT�SURCI-IARGG is.000�of the contract price under�1,000,000 0;�.50-whichever is greater. For valuations over <br /> �1,000,000 call the Department of Inspectional Services for the price. <br /> The undersiened hereby applies to the City for i;suance of a Mechanical Pern�it,agrees to do ali work in strict accordance with <br /> thc ordinances of the City and the regulations of the Minnesota State Building Code,and certifies that all statements made un this <br /> application are complete,true and corr t. <br /> Applicant's Signature: Date: C"J �' �i- <br /> Approved By: Date: <br /> 3 i <br />