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07-21-'16 12:36 FROM- F I RES I DE T-316 P0403/0404 F-845 <br /> ', <br /> '����'� �y� ����" � � . < r F�Y�" ��'�U��+I�" ���y�i 7Y�y� z i <br /> "A �� �!A �tt ��'���5`� .l ''��r <br /> � _'� �.r .i r� ,i.: s � � .��r�n �..,�W,1�� �a�},,. ,�" . <br /> � �'- 's '�r*, �.,:��� <br /> ❑ Yes,this scction applies <br /> The rcplacomont of a Residential fixture or��pliance thst meets all three of the following requlCements: � <br /> l. Does not require modification to electrical or gas serviee. <br /> 2. T-�as a total eost of$500.00 or lass;excludine the cost of the f xture or appliance:and <br /> 3. [s impro�vcd,installed or replaced by the homeowner oC licensed ContraCtor. e <br /> t <br /> 5kip next section,if'this applios; Cost of perntit $ t5_00 � <br /> St2te Surcharge $ 5.00 � <br /> Mail-Ia�Fee(If Applicabla) $ 2.00 ` <br /> Total Permit�ee $ � <br /> i <br /> i <br /> ) <br /> Cfabove does nat apply;follow guidelines below: � <br /> 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> / QP p0 <br /> �'���0, x.0125$ �Q. <br /> contract price) (minimum 554.00) <br /> ?. S'X'A'C'�SC�RCHAR�E ���� o� It ' � e <br /> , x.0005 $ � � <br /> '�(conaact price) � <br /> 3. POSTAGE&HANDLING{dnl�on M&il-In Applications) $ � � <br /> 5�. � 7 � <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ i <br /> I <br /> � * CONTRACT FRICE or JOB COST means the 2ctual or estimated doll�r amount charged for the � <br /> perm►tted work including materials,labor,profit,and other fixed costs. 1t is the annount to be charged i <br /> Eo the customer for thc work d4ne. If any materiRl,ecjuipment, labor or installations are furnished by � <br /> thc owner,tcnant or any other party,the reasonable market value of such itcros must be added to the � <br /> -- esfimated-cost-orcontraot�pricc�for-permiY-fee-purpose3.--Cn•the event-that-there-is`a'dispute-�n�the <br /> amount of the job cost,the City may requcst thc submission of a signed copy of the actual contract. <br /> .,., .� - f� - �� y - � - i2 �-;� <br /> Y b! <br /> The undersigned hereb� applies to the City for issuance of a Mechanical Permit, agrees to do all <br /> work in strict accordance w'rth the ordinances af the City and the regulations of the StaTe of <br /> Mrnnesota, and certifies that all staternents made on this applieation are cornplete, true and <br /> correct. <br /> Applicant's Signature: � �i��`r Date: ����r��/ <br /> 3 <br />