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11-30-'16 15:11 FROM- T-480 P0003/0416 F-583 <br /> . . . - � <br /> f,;''�����, � .r���i°,;z-� _�P�1�T�"����UC�L,:���C�N.��) ' � ~�'' �-` T <br /> ua sx r t �. <br /> � ��,�� , ,��h i.. �'�j�. y�.� �p A /� Cr 1 r .� ,�;a„��}�. r[��"`x� c...�.a y�, ,�;, <br /> Ir�'st�� �. -' > Sr ^��. r�l4 ,-.U��I����J�'��-�r��.af�F�`�A����-1�1�. +_�Cr� t`x., 't..`1-.� 1 =:'_�.3 <br /> ❑ Yes,this section applies <br /> The replacement of a�esidential f,xture or appliance that meets all three of the Following requirements: <br /> 1. Do�s not require modification to electrical or gas serv'see. <br /> 2. Has a total cost of$500.00 or Iess;excludinz the cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by thc homeowner or licenscd contractor. <br /> Skip next sectron,'rf this applies; Cost ofPermit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Pee(Tf Applicable) $ 2A0 <br /> Total�'ermit�ee $ <br /> , . � �,^�. (� ]' (� I <br /> 5�� .Yi2 a�`aa�.��� _ =s�. �d��i=�, T � �l�C �� ��- '' �:1.�' '� - �� �-��i <br /> Tf above does not apply;follo�v guidelints below: <br /> �. c.arrrrtACT P�TC� *i3 1.25%of contract price with a(Minitnum�ee of$50.00) <br /> ���� x_0125 $ �� <br /> {contracc pricc) ( nimum 550.06) <br /> 2, S7'AT�SCJrtC1�TARCE ��7� �',� � <br /> x.0005 $ � <br /> (Conlract price) <br /> 3. 1'OSTAC$&HANDLING(pnly an Mail-In Applications) $ Z.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ (dtl 3� ^ <br /> ■ � CONTRACT PR10E or rOB COST means the actual or estimated doUar amount charged for the <br /> permitted work including rnaterials,labor,profiC,and other fixed costs. It is the amount to be charged <br /> io the Customer for the work done. Tf any matcrial, equipment, labor pr installations are furnished by <br /> the owner, tenant or any other party,the reasonabie market value of such itcros must be added to thc <br /> estimated cosk or contract priee for permit fee purposes. Tn the evenC 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 /> .._. _ <br /> ���4�,.��is":.����"__�����-. a���`�� ��,_� �a�'� �7 _� ;� ��:; � . <br /> �� :�>��. <br /> The undersigned hereby appl'res to the City far is3uance of a Meehanical Permit, agrees to do all <br /> wOrk in strict accordance with the ordinances of the City and the regulafions of the State pf <br /> Minnesota, and certifies that all statements made on this application are complete, true and <br /> CpCCCCt. <br /> Applicant's Signature: . � � �• Date; � / <br /> 3 <br />