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. . . <br /> r . <br /> �"�+��a���'�'�+E �AL,C'IlI.FS.T'IC�N(S) <br /> 20Q2 Sta�e Stata�te ❑ �'es �'his�ecfion P��pIaes <br /> The replacen-ient of a Ptiesidential fixture or app]iance that meets all three of the following requirements: <br /> ]) Does not reqtiire modification to electrical or gas service. <br /> 2) Has a total cost of$500.00 or less; excltidii7� the cost of the fixture or appliance_ <br /> and <br /> 3) Is improved, instalied or replaced by the homeowner or Iicensed contractor. <br /> Skip next section; Cost of Permit $ 15.00 <br /> State Surcharge $ .50 <br /> Nail-In Fee $ 1.50 <br /> If above does not apply, follow guidelines below: <br /> 1. �'oaa�r��t �'�s�e* �s .0125°ro of job with a l�fns�y�u� �ec af (��5 �0� <br /> c_�,�'�,��� x .0125 ; ��" <br /> � ��_ <br /> (contract price) (minimu�n�35.00} <br /> 2. Sta�e ��rs���sar<Tee *� Add the State Building Code Division a 1Vbin�m�m �e�mf � .S� <br /> ���'�"�1� x .0005 � �. �f�� <br /> (contract price) (minimuin$ .50) <br /> 3. �'Qs���e ��d I��az�IiinQ (E1riP���rz�cil-iri c��r��liccati�»ts) � -'� <br /> 4� ��'��'�� ���'��� ��:� (Add lines I-3 above) $ ��� �,� <br /> *CONTRACT PRICE�or.1pB COST means the actual or estimatec dollar amount charged for the��ermitted worlc ineluding <br /> n��terials,Iabor,profit;and oil�cr fixed eosCs.Tt is the amount to be charged to the customer for the worl;donc.If an}�matelial, <br /> equipr7�cnt, fabor,or inst�allation is furnished by thc ow�er,tci�ant or any other party the reasonable markeY vali��of suc}i items <br /> rnust be added to T}��e estimated cost or contraci price for penriit fee purposes. In Che even[that there is a dis}�ute on the amount e,f <br /> the job cost,the Ciry may request�the submission oi a signed copy oi the actual contract. � <br /> *'a`The STATE SURCI IARGE is.0005 of thc contract price under$1,000,000 or$.50-whichever is greater. For valuations over <br /> �1,000,000 call tne Department of Inspectional Scrv;ces for the price. <br /> The undersigned hereby applies to the City for issuance of a iviechanical Pen��it;agrees to do all u�ork in strict accordaiice with <br /> Che ordinances of the Ci[y and the regulatior,s of the Ninncsota State I3uilding Code,and certifies that all statements macie on this <br /> application are complete,true and corr t. <br /> Applicant's Sib ature:_ �. ���.._. Date: „ a �, <br /> Approved By: <br /> Date: <br /> 3 <br />