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11-21-'16 13:08 FROM- T-429 POOQ3/0004 F-522 <br /> . , <br /> � rti,<"�r`^t,�,Y`"�Y+•�r�'14��`i'y'A3��Ytytq�. y � ! Tl �I � �\el � ���2 k..J.�tf ;Yl'v�'��'�2���� i�?�:� <br /> ��yrj,��� �. ✓ �����h i���,� . � . 1 ]�' �.' tk� �j �4k a.aw�'�7`�r'�r "q t�'., � <br /> t' � 1. 't 4�j � �'4 >'�+� 6`F� ' <br /> .���.���.��''F,��,�� 2���+1SF�t=�nf,���. .._�...._ ..dQ��,.������!:���.`s�::.r���„���3����i-����-.-.�r�^�4 <br /> �] Yes,this sectiai�applies <br /> The replacemont of a Residontial fixture or appliance that meets all three of the following requirements: <br /> 1. Does not requ;re modification to electricai or gas service. <br /> 2. T�as a tot�l cost of$500.00 or less;exeludi�i�the cost of the fixture or appliance:�nd <br /> 3. 1s improved,inst�lled or replaced by the horneor�vner or licensed contracGor. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-InFec(IfApplicable) $ 2.00 <br /> Tot�l Permit Fee $ <br /> I� ���"���:���"`��"`�`�� :���`��5 a��` -�,�1 <br /> If above does not apply;foilow guidelines below: <br /> l. C4NTC2,4C�'��tXC� �is 1.2>%of contract price with a(I���n►naum�ee af$SOAO) �� <br /> p� x.O 1 z5$ �5, �S , <br /> (contraci price) (minimum 550.00) I <br /> 2. srAT�s�u�c��n�,� J� a5' 23 , <br /> -( ��. x.0005 $ �• <br /> (contract priCG) <br /> 3. POSTAG�&HANb�.TNC�?(Only on Mail-Tn Applications) $ �9 � r <br /> �jf� Q� �Q� ' <br /> 4. 'Z'OTA���Xtl�l'Z'���(Add T.ines 1-3 fl,bove) S v v ' <br /> ■ �' CaN'TRACT PItICH or 1pB COST means the actual ar estim�ted dollar amount charged for the ' <br /> permitted work including m�terials, labor,profit,and pther fixed costs. Tt is the amount fo be charged <br /> to the customer for the tvork dont. If any material,equipmtnt, IAbor or instAllAtlons Rre fiirnished b� <br /> the owner,tenAnt or an�other parry,the reasonable market v�lue of such items must be added to the <br /> estimated cost or contrAct price for permiG fee purposes. Tn the event [hat tlicre rs a dispute on the <br /> amount of thc job eost,the Ciry may rec�uest the submission of a signed eop� of the actual contract. <br /> y r; *+�' � '� r- y•,r .y-.. .� ��, <br /> lY �' <br /> � <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit,agrees to do all <br /> r�vork in strict accor•dar�ce w'rth the ordinances of the City and the regulatioris of the Stftte of <br /> Minnesota, and certifies that all statements made on this application are complete, �rue and <br /> correct. <br /> ' ' 11��i � <br /> Applicant s Signature: Date� � �(Q <br /> 3 <br />