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11-01—'16 12:02 FROM— T-335 P0003/0004 F-415 <br /> . <br /> .�y,V� �, d� , t��*�}�y j$,�,n � . w '? . 1- _� � - �y'n, --- �� <br /> ���x ky �, t� J _�.��� �A Jy� ` A � . " ':t <br /> � '�iyi�.l w«�{,L ?��.�'�h.:.� � •e�` .�,�'h�42k 5..'i:�' ' �1. _.W fi' � <br /> , � &.a <br /> Q �Yes,this section applies <br /> The replacement of a Rosidcntiai fixh�re or appliance Chat meets all thrtt of Che follo'wing requiremenYs: <br /> 1. Does not reyuire modification to elcctrical or gas service. <br /> Z. T�as a total cost o�$500_00 or less;excludin�the cost of the frxkure or appliance:and <br /> 3. Ts improved,installed or replaced by the homeowner or licensed cpntractor. <br /> Skip next section,if ttiis applies; Cost of Permit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-Yn ree(Tf Applicable) $ 2.00 <br /> Tot�l Permit Fee $ <br /> ��:1 ,� 'iill'i�'Lh:V..LRFJ`6'� � �.oA� 4i'f' µ"' <br /> If abovc docs not appl�;follow guidelittes beloW: <br /> 1. CON'X'�2A,CX'p�tTCE *is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> �-9��I I9. i o X.o�a5����:�� <br /> (coniract price) (n�inimum�59.00) <br /> 2. STA'�'E SYI�LCHARGE �� , L O q f(� '-�� <br /> 1 `'( �c.0005 $ . <br /> (contract pricc) <br /> 3. pOSTA4E&T-TAND�,zNG(Only on Mail-Zn Applications) � <br /> �? . ..��-.... ..... . . . <br /> 4. T01A.Y.,�k.�iMXT F��(Add T.ines 1-3 Above) $ �U �- <br /> ■ '� CONTRACT PRTCE or JOB COST means thc zctual ar estimatcd dollar amount Cliargtd for the <br /> permitted wqrk including matcrials,labor,profit,and othcr fixed costs. It is the amount to bt Charged <br /> to the customer for the work done. If any material,equipment, labor or installations are furnished by <br /> the owner, tenant or tsny other party,the reasonable market value of sucli iterns must be added to the <br /> estim�ted cost or contract price �'or permit fee purposes. Yn the event tlzat there rs a dispute on the <br /> amount of ttie job eost,the City m�y request the submrssion of a signed copy of the actual conkract. <br /> 7�. ` �'�.�_. _ � - <br /> The undersigned hereby applies to the City for issuance of a Mechanical Pennit, agrees to do all <br /> r.vork in strict accordance with the ordinances of the C'rty and the regulations of the State of <br /> Minnesota, and certifies thaC all st�Cements m�de on this, application are complete, true and <br /> correct. <br /> � <br /> Applicant's Signature: _ _ Date: �I�/"�lCp <br /> 3 <br />