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� � <br /> :::;^51� ,z5� ti�� u \.r�'' �,F���;"�"''.E,ll.."' �t"I:A��'.'VL�L��1��,���� i�� � ...,��� '\. <br /> ;... .�� :� � , ���� �, .. <br /> • >:; ti .:;; .��;� l�.C}�•�'-��2002 S�'���,STATL7E :. <br /> L� � . .,,� . ,::,.. . .c,;:. '. <br /> :Y��. � 1 a� e <br /> 0 Yes,thas section applies <br /> The replacemer�t of a esidcntial fxture r a 'ance that meets all tfaree ofthe following requirements: <br /> t. Does_t�SLc require modifcation to eaectrical or gas service. <br /> 2. Has a totai cost of$500.00 or iess;excludin�the cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homcowner or licensed contractor. <br /> Skip next section,if this applies; Cost of�ermit $ t 5.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> 'I'Ota1 Permit Fee $ <br /> �x.;:�; <br /> � �p��T���`CAT����,�'�'IibN S '='7(��S.-OV�'�.$SOU:C}Q "., ;. ,,",R �,;.;.:. <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRiC,� * is 1.25%of conCractpT�ce with a(Minimam Fee of$50.00),�,J-� <br /> ���� U� <br /> X_o�zs$ <br /> (contrt�ct pnce) (minimum�50.00) <br /> 2. STA.T�SU�2CHARGE � <br /> 1b�o X.�ao> � n � <br /> (cOniract price) <br /> 3. POSTAGE&HAND�.CNG(Only on Mail-In A,p�lications) $ 2,OQ <br /> �.J� <br /> 4. TOTAL�'ERMI'�FEE(Add Lines 1-3 Above) $ �� <br /> � "` C4NTRACT PRICE or Jb8 COST means the actual or estimated dollar amount charged for the <br /> permitted work including materials,Iabor,profit,and other fixed costs. [t is Yhe amount to be charged <br /> to the customer for the work done. If any material,equipmen[, labor or instaliations are fi�mished by <br /> the owner, tenant or any other party,the reasonab#e��arket vafue of such items must be added to the <br /> estin�ated cost or conCract price for permit fee purposes. In tkae event that there is a dispute Ott the <br /> amount of the job cast, the City may request the submission of a signed eopy of ihe actual contract. <br /> �;;';. . iV��:�T�CAT�PEI7NIIT API�LZC`A`,l�b�'�1?�Y��C.xYt�EIV1�N'� ,, �'", <br /> The undersigned hereby applzes to the City for issuance of a Mech2rtical�ermit, agrees to do all <br /> work in strict accordance With the ordinanees of the City and the reguiations of the State of <br /> Minnesota, arcd certifies that a]I statements made on thzs application are complete, true and <br /> correct. ' <br /> Appl icant's Signature: Date: �J�/J� <br /> ( ��"'"''"� - . <br /> 3 <br />