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. <br /> � � FER�II�I' �'E 1 C�`��ll ( t�s��+ � ;i>�ai�� ------- --------- <br /> � _,� bASI�_C?f)F'f_''�02 �_1�,�4;f ST,�?��E - -- � <br /> [] Yes,this section applies <br /> The replacernent oFa Residential fixture or appliance that m�:ets ail three�f the following requirements: <br /> l. Does not recjuire modific;atian to electr�cal or F;as service. <br /> 2. Has a tc�tal cost of$SQ�.QO or less;�xciudin the ct�st of the fixture or appliance:and <br /> 3. is improved, iitstalled or replace�by tne hem�owner or licensed contractor. <br /> Skip next secti�n, if th�s appli�s; Cost of Permit $ i 5.00 <br /> State Surcharge $ 1.00 <br /> Mail-In Fee(If Applicable) $ 2.01� <br /> "fotxl Permit Fe� � <br /> �__f Pt�.R�1T����.����iIATIC�N���—JOBS (?VER$500.0{� � <br /> lf above does not apply;follow guidelines below: <br /> i. CONTRACT P12lC'E M is I.2�°�of contract price�i ith a(Minirr�um Fee of�50.00) <br /> S'G�� x.0125� '�OC� <br /> contract pr�•e) (minimum 550.00) <br /> 2. STATE SURCHARGE - �,�q�) /� <br /> _�S'��- " X .000s �-- a�� <br /> rontract pricel <br /> 3. POSTAGE&HANDLING(Only on N9ail-in Applicationsj $_ � 0 <br /> � <br /> 4. TOTAL PERMIT FEE(Add L.ines 1-3 Above) $ ��, � _ <br /> ■ * �UNTRACT PR1CF, or JOB COS1 mears the actual or estimated doilar amount char�ed for the <br /> permitted work including m�terials, la�+��r, protit, �nd other fixed costs. IT is the Amount to be chargeci <br /> to the cusromer for ihe werk done. If«ny matcrial, equipment, �abor or installations are furnished by <br /> the owner, tenant or any other�ar?y,the reasonablz market value of such items must be added tc� the <br /> estimated cost or contract price for permit fee purposes. ln the event that there is a dispuYe on the <br /> amount of the job cost, ihe City� may request the submission of a signed cap}� of the actual contract. <br /> NtFC�it�I*tI�:AL��Rl�"�`���:�,�"��,��r.��1�1�NT �; <br /> �� - <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all <br /> wark in strict accordance with the ordinances of the City and Che regulations of the State ot <br /> Minnesota, and certifies that all statements made c�n this application are complete, true and <br /> correct. <br /> Applicant's Signatur�. _ ��' __ Date:���� �� <br /> 3 <br />