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Q1-23-'15 15:29 FR4M- T-391 P0006/0007 F-531
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<br /> ❑ Yes,this seotion applies
<br /> The replacement of a Rgsidential fixture or appliance that meots all threc o€the follo�ving requirements:
<br /> 1, Does noY require mod�fication to electrical or gas service.
<br /> 2. Has a total cost of$500.00 or less;e c�clud.it��the cost af the fixturc or appliance:and
<br /> 3. Is improved,installed or replaced by the homcowncr or lieensed contractor. �
<br /> Skip next section,if this a�plies; Cost of�'ermit $ 15.00
<br /> Statc Surcharge $ S.OU
<br /> Mail-In Fee(If Applicable) �w_��0
<br /> ToCal Permit�'ee $
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<br /> �,�"V.,.m,_...., ;
<br /> Jr'`.�r>�'S��y �� '� 'L�ET�h�[7�'�'� CA'�.G�'i:J�,f1.'�'T(aN(�).,�7(1$�.�?VE�',��09.00;.',,` ;
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<br /> if above does not apply; follow guidelines below:
<br /> I. COIVTX2ACT PT2TC� � is 1,25%of cantract pricc wiYh a(Minimum Fee of$50.00)
<br /> �1J x.0125$ � 1 �_�
<br /> (coniract price) (minimum 530,00)
<br /> . 2. STATE SURCHARCE 1�. ( �{, Oc�j
<br /> — l 1 �� x.0005 $ �_ , ,��1�
<br /> (contract price)
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<br /> 3. POSTAGE&HANDLING(Onl�on Mai1-Cn Applications} $ 2.00 €
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<br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) 5 �--•� �
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<br /> ■ '� CONTRACT pRIC� or JOC3 COST moans tha actual or estimated dollar amount charged for the '
<br /> peCmitted work including m�terials, labor,proft,and othEr fixed costs. It is the amount to be charged '
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<br /> to the customer for the work done. If any material,equipment> labor or installations arc furnishcd by ±
<br /> the owner,te»ant or any other party>thc roasonablc market value of such items must be added ro the
<br /> CSt1�71atCd COst or contract pricC fOr permit Pee purposcs. In the event that there is a dispute on tlie f
<br /> amount of the j�b eost,ehe Ciry may request the submission of a si�ned copy of the actual contract. �
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<br /> The undeisigned hcrcby applies to ihe City for issuAnce of a Mech�n'rcal Permit, agrees to do all
<br /> work in strict accordance with the ordinanees of the Ciry and tEie regulations of the State of
<br /> MinnesotA, and certifies that all statements made on this appliCation arc complete, truc and
<br /> conect.
<br /> Applicant's Si�nature: �ate: ` �J
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