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� <br /> �'ERIVII'� �'EE �ALC�TL�TIE�?�(Sl <br /> 2002 State Statute ❑ Yes This Section r��plies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requirements: <br /> 1) Does not require modification to electrical or gas service. <br /> 2) Has a total cost of$�00.00 or less; excludin� the cost of the fixture or appliance: <br /> and <br /> 3) Is improved, installed or replaced by the homeowner or licensed contractor. <br /> Skip next section; Cost of Pennit $ 15.00 <br /> State Surcharge $ .50 <br /> �ail-In Fee $ 1.50 <br /> If above does not apply, follow�uideIines below: <br /> �. �'r�i3��•�ct �'F•ia�e* is .012�°io of job v�ith a]�F���r��um �;ee of(x:��e(30) <br /> �"S �=�. :;:� x .0125 � `> �= �� <br /> (contract price) (minimum�35.00) <br /> 2. State �urchar�e. ** Add the State Building Code Division a�i'�ira�mum �'ee o$'(� 50} <br /> J���. - x .0005 $ �� .� S. <br /> (conEracC price) (minimum� ._50) <br /> 3. P€�s�a�,re ai�d�-I�ndiin� (�ttc�y mai�-ir� ap�licatiorzs) $ <br /> _ -��_._____ <br /> 4• �'��'�� �'���I�' �'�� (Add� lines 1-3 above) � `j���' ,�-1; <br /> *CUIvTRACT PRICE or.IOB COST mear,s the actual or estimated dollar amouni charged for the permitted�rorl<including <br /> materials,labor,profit,and other fi>;ed costs. It is the amount to be charged to t�he customer for the work done.If any maCerial, <br /> equipment, labor,or instaliation is furnished by the o�vner,tcnant or any other party thc reasonable market value of such items <br /> must be added to the estimated cost or contract price fo;permit fee purposes. In the event that there is a dispute on the amount of <br /> thejob cost,the City may request the su�mission ot"a siened copy of the actual contract. <br /> **The STAT�SURCI-IARGE is.0005 of the contract price under$],000,000 or$.50-whichever is greater. For valuations over <br /> $1,000,000 call the Department of Inspectional Services for the price. <br /> The undersiAned hereby applies to the City for i;suance of a Mechanical Pern�it,agrees to do all v✓ork ir strict accordance with <br /> the ordinances of the City and the regulations of the Minnesota State Buildin�Code,and certifies fhat all statements made on d�is <br /> appiication are complete,true and correct. <br /> Applicant's Signature: � ��:,ZL�C',c, �v Date: �� �'��� � <br /> Approved By: I Date: <br /> 3 II <br />