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11-30—'16 15:12 FROM— T-480 P0009/0016 F-583 <br /> �� _�K�h�.�f r F54�s♦MY,�'�-:� �������J..f�'i('�.]vf1J-.��i�.I�7�-�Jj . �. �r-=�z�,.^�_�•.. � � <br /> � dFi�. Y� l.� lx� `-L�}Ay�} rCG 'f 'yc �.,,�y.y?pw a -G !� .C.c Ff i+ ��s,+r�. <br /> .td rrk r-�cl��Y _�:t�"i}>�' � �..:.l.L�?r?�_ �<L�.�_z��Q',�.'�"7'.�1_�'?r�,�iTE�"1 U�;�.�`s` ��- _ ;'� r _ -�;' <br /> �� - - _ <br /> ❑ Yes,this section applies <br /> The rcplacement of a Residential fi ture or a lianco that meets all Chree of the foUowing requirements: <br /> 1. Does not requirc modification to electrical or gas service. <br /> 2. I-�as a total cost of$500.00 or less;excludin�the cost of thc fixture or a�pliance:and <br /> 3. Ts improved, installed or replaeed by the homeowner or licensed contractor. <br /> Skip next section,ifthis applies; Cost ofpennit $ 15.U0 <br /> 5tatc Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2,00 <br /> Total Permlt�'ee $ <br /> °x��y���T� '�:���'����'_ � -�,' "�:` `=- .�� '4��'fE - .���� �_�<��' _� <br /> ��--- <br /> lf above does not apply;follorv guidelines below: <br /> I. CONTRACT��iICE *is 1_25%of contract price with a(Minimum Fee of$$Q,00) <br /> a � x.0125$ ��� <br /> (contracc pricc) (minimum$50.00) � <br /> 2. STAT�SYJ�tCY-YAIZGE ��C�a� X,0005 $��� <br /> / <br /> (Contr�Ct price) <br /> 3. PQSTACr�&HANDLING(Only on Mail-In Applications) $ ,_,,,,,2.00 _ <br /> 4. TOTA�,P�RMIT FEE(Add�,ines 1-3 Above) $ � <br /> %� <br /> ■ * CONTRAC"t' PT�1C� or JOB CpST means the actual or estimatzd dollar amount charged for the <br /> permitted work including materials, labor,profit,and othcr fixed costs. Ct is the amount to be charged <br /> to the eustomer for the rvork donc. If any material,equipment, labor or insiallaCions are furnished by <br /> the owner, Ccnant or any other party,thc reasonable market vatue af such items musC be added to the <br /> estimated cost or contract price for percnit fee purposes. In the event that there is a dispute on the <br /> amount of the job cost, the Ciry may requcst the submission of a signed copy of the actual contract. <br /> ��,t2�'£9�l�.l����"'��4� a�z��Y�� ...�.,' li.F�l3a 'b,iA�v � _ `� �. .f�t':4,�. ��A�1�..��IYLL'll_V"J.��.�k�.'�-ry�� .�. x.��&. <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, ag�eeS to do all <br /> Work in strict aceprdance with the ordinances of the City and the rogulaCions of the State of <br /> Minnesota, and certifies that all statements made on this application are cornplete, true and <br /> COrrCCC. <br /> f f . ,,,, l <br /> Applicant's Signatur�; Date: �� <br /> 3 <br />