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c <br /> ❑ Yes,this section applies <br /> The replacement ofa 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. Hasa total cost of$500.00 or less;excl mins the cost ofthe fixture or appliance:and <br /> 3. Is improved, installed or replaced by the homeowner or licensed contractor. <br /> Skip next section,ifthis applies; Cost ofPennit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mai)-InFee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> Ifabove does not apply,follow guidelines below: <br /> 1. CONTRACT PRICE * is 1.25%�(ofcontractr e with a(Minimum Fee <br /> (o�f'$'j50.000)) <br /> x.0125 $ I V I ( J l/ <br /> (contract price) (minimum$50.00) <br /> 2. STATE SURCHARGE <br /> x.0005 $ (J <br /> (contract price) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> C804. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ ` 1 <br /> ■ * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the <br /> permitted work including materials, labor,profit, and other feed costs. It is the amount to be charged <br /> to the customer for the work done. If any material, equipment, labor or installations are funiished 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. <br /> The undersigned hereby applies to the City for issuance of 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: Date: ' `-t'– — <br /> U0--" <br /> 3 <br />