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05-06-'15 14:30 FROM- T-785 P0003/0004 F-959 <br /> y, y <br /> i <br /> p h h <br /> [� 'Yes,this section applies <br /> The replacement of a ltesidenti fixture or liance that meets all three of the following requirements: I <br /> 1, Poes not require modification to electrical or gas service. <br /> 2, Has a total cost of$500.00 or less;excluding the cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor. <br /> Skip next section,if this applies; Cost of Pen-nit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> � <br /> Total Permit Fee $ <br /> ` y� Uffffi <br /> §R1 0"I K <br /> N f.�C9 ` ',.t .kl, ,h' t asF iiVF.'F <br /> If above does not apply;follow guidelines below; <br /> I <br /> { <br /> 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> s <br /> $5.9D2.60 <br /> OEM; (viiiilm_u 4(zQ <br /> 2, STATE SURCHARGE <br /> T x;OQ.iS,il,$ 2.95 <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) <br /> lications <br /> I <br /> F <br /> 4. TOTAL PERMIT PEE(Add Lines 1-3 Above) <br /> • * CONTRACT PRICE or JOS COST means the actual or estimated dollar amount charged for the <br /> permitted work including materials,labor,profit,and other fixed costs. It is tite amount to be charged <br /> to the customer for the work done. If any material,equipment, labor or installations are furnished by <br /> the owner,tenant or any other party,the reasonable market value of such items must be added to the € <br /> estimated cost or contract price for permit fee purposes. In the event that there is a dispute on the <br /> amount of the job cost, the City may request the submission of a signed copy of the actual contract, i <br /> i <br /> k <br /> 1 <br /> 1 <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit,agrees to do all <br /> work in strict accordance with the ordinances of the City and the regulations of the State of <br /> Minnesota, and certifies that all statements made on this application are complete, true and <br /> correct. <br /> Applicant's Signature: <br /> .. ;,3 516!15 <br /> 3 <br /> 3 <br />