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11/15/2016 TUE 16: 19 FAx 612 822 5408 A1' � MA�ter Plumqimg �00�/044
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<br /> ❑ � Yes,this section�pplies
<br /> The replace�nent of a Residentifll fixture or apptiancc that meets �ree of the�'ollowi�ag requirements:
<br /> E 1. Does nat rcquire modification to electrical as service.
<br /> �` 2. Has�total cost of$500.00 or less;exel n the cost of thc fixture or appliance:and
<br /> , 3. Is improved,installcd or rcplaced b e homeowner or licensed contractor.
<br /> � Skip next section,if this Ap ' s; Cost of Pcrmit $ 15.OQ
<br /> State Surcharge $ 5.00
<br /> MAiI-In Tee(lf Applicable) $ 2.00
<br /> , Total Permit Fee $
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<br /> if above does not apply;follow guidelines below:
<br /> l. C;ONTRACT PRTCT *is 1.25%of contrAct price with a(Minimum Fee af$50.00)
<br /> � �'d-QU x.0125� � � ��U
<br /> (coniract pricc) (minimum$50.00)
<br /> 2. ST'ATE SURCHARGE ` A ;(�� `�,
<br /> _ `�� �/�� x.�005 5 �p `tJ
<br /> �(cnntract pricc)
<br /> 3. POSTAGL&1-lANDLING(Only on Mail-Tn Applications) $ 2.00
<br /> 4. TOTAT.�'TRMIT TEE(Add Lines 1-3 Above) $��� .�(�
<br /> ■ * CONTRACT PRICE or JOB CQST means the actual or estimated dollar amount ch�rged for lhe
<br /> pennirted work including m�teriAls,IAbor,prorl,and othcr fixcd costs. it is the amount to be charged
<br /> to the cusiomer for the work done, If any matcriat,equipment, labor or installatzoaas are fur�xiskaed by
<br /> thc owncr,tenant or any other party,t�xe reasonable market vAlue of sueh items must be added to the
<br /> estimated cost or contract price for permit fen purposcs. In thc cvcnt that there is a disputc on the
<br /> flmount of thc job cost,thc City may request the submission of a signed copy of the actual conuact.
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<br /> The undersigned hereby ap�lies to the Caty for issuance of a Mechanical Permit, a�;rees 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 mad is a��ilicatiqn arc cpm�lctc, truc and :
<br /> correct.
<br /> Applicant's Sibnature: Date: ` � / � � /�`f�
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