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From:Jennifer Sinkie Fax:(888)550-9203 To: +19522494616 Fax: +19522494616 Page 9 of 10 1212012011 8:13 <br /> . � <br /> , ' " �e`�z�3 �' -.`� -r���-+�'�� �.��r� 1;�v� � �(' <br /> 4° ti ���''��r i::l a/ ?�> �.i�T �.r�src ry;�.�,_'`_'.l��„�L' �.: C� u!�IV �._t �' fi,'f Y'`�?'���r j�� F.. >� .i-:! <br /> / - h- �. Y.4yyF6�'�. s w�' � 3��/ a � a�f'.�,�5(;�1 n-, �.:��� ��+ �' "� i <br /> �� ),jt]f��i� „5°r�{� ,^�1i31 F.y t'8����y,'�.l:1,�f:�� Tr t t �Z � <br /> r,., n� ,� <br /> .3 "` , !� - - :_ ..�� .�. s.z.,� <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or aopliance that meets a11 three of the following requiremeuts: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excludine the cost of the fixhue or appliance: and <br /> 3. Is improved,installed or replaced by the homeowner or lice�ed contractor. ' <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ .SO <br /> Mail-In Fee(If Applicable) $ 1.50 <br /> Total Permit Fee $ <br /> , _ _ <br /> �.` _ 1'' � '` .Q. . ;� � <br /> +� � tb . , i {�'' ` �'' <br /> If aboVe does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee o[535.00) <br /> �. �� �O x.0125$ � <br /> (conttact pricc) (minimum S3�.OU) <br /> 3. STATE SURCFIARGE ** AJcI e State Bldg Code Div. Surcharge(�Iinimum Fee of�.50) <br /> x.0005 � <br /> (contract pricc) (minimum S .SD) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $_ I.50 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ <br /> ■ " CONTRACT PRICE or JOB C05T means the actual or estimated dollar amount charged for the <br /> permitted work including materials, labor,profit, and other fixed costs. It is the amount to be charged <br /> to the customer for the work done. If any material, equipment, labar or installations are fiunished by <br /> tbe 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 pemut fee purposes. In the evenf that there is a dispute on thc <br /> arnount of the job cost, the City may request the submission of a signed copy of the actual con�act: <br /> • "'*The STATE SURCHARGE is.0005 of the Building Deparhnent at(952)249-4600 for the price. <br /> {,: j riw ����� ';� ` � :�, �' J5 ��' r,,�.,��„�� �4�� r' � � <br /> . ,�, . , .. • � <br /> _.�; n <br /> The undersigned hereby applies to the City for issuance of a MechanicaI Permit, agrees to do all <br /> work in sh-ict accordance with the ordinances of the City and the regulations of the State of <br /> Minnesota, and certifies that all statements made n this application are complete, true and <br /> correct. ) <br /> � <br /> Applicant's Signature: Date: �Z �0 -�f� <br /> 3 <br />