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J � <br /> F�1`u'P�t� PL'�'i ��L�Cl���F�l'Y{t71 <br /> 2002 Sta�e Stataate ❑ �'es T'his Seetion��pIies <br /> The replacenlent of a Residential �r,ture or a�spliance tl�at�neets aIl three of the followin�re�uireinents; <br /> 1) Does not require modification to electrical or gas service. <br /> 2) Has a total cost of 5�500.00 or less; excludine 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 Pennit $ 15.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee $ 1.50 <br /> If al�ove does not ap�ly, follow buidelines below; <br /> '�. �;'ont�-��t I'f•is�e�� :s .0125% of job witll a 1��Er�efl�lurn ��ec �f(��5 00) <br /> - � <br /> C�).U` � .o12s � S S�_> <br /> (contract price) (minimum�35.00) <br /> Z. Statc �ijrc���arme. *� Add the State Buildin�Cade Division a 1�'finimum �'��of(S 5�) <br /> � � � x .OQOS �, .<���__ <br /> (cont�ract�price) (rrunimum� .�0) <br /> 3. �'€as�a�e ��a� ���aadtita (�szly t�zrcif-in applicatio�rs) � <br /> �� <br /> 4. '�'CB'�'�L �'������' �'��; (Add Iines 1-3 at�ove) � �\�- �"� <br /> ��CO?�TRACT PRICE�or.IC1�'COST means the actua! or estimat�d dollar amount�chargecl far the permitied worl<ir.cludin� <br /> maCeriais,labor,profit,and other fxed costs. it is the a�r�o�int to bc charged to the customer for d�e wori;done.If any material, <br /> equipr��ent, labor,or inst�aliation is furnished by tl��e owr�er,tcn�nt or any other party t}ie reasonable mar]cet value of sucti iYeiris <br /> r�iust be added to the estimat�d cost or contract price for permit fee purposes. In Yhe event that there is a dispute on the arnount of <br /> thejob cost,the Ci?y may request the submis,ion oi a signed copy of the actual contract. <br /> **Tne 5T4T�SURC7-IARCE is.0005 of thc contract price under:�1,000,000 or$.50-whichever is greater. For va)uations over <br /> �1,000,000 call the Department of Inspectional Scrvices for the price. <br /> The undersrgned hereby appiies to tne City for issuance of a Mcchanical I'em�it,agrees to do all v,�ork in strict accordance with <br /> the ordinances of the City and thc regulations of the Nimicsota State Iiuildin�Code,and cenifies that all statements made on this <br /> application are camplete,true and corr „ . <br /> � <br /> �lpplicant's Si�nat�ire: _ ���Lc:L�.- _ ,;��,.�= Date: � �� � <br /> � � <br /> l:p�rovcd By: i <br /> Date: <br /> 3 <br />