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� , z ��� y�k� TT���C�I.L��>�T��3N��� <br /> , ���� � ;, ��_. �,, <br /> �. <br /> , �,.. , k..��... ;�� ,��. �.�3',� �� ��`�'�-.������'��'�r�t�`I`tJE� �` ., � <br /> � Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requirements: <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 fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> , „ <br /> ,� <br /> � : , � �C�:l�.f��'�4� S.—�QBS€��IER"$�(�4l«i#{l ' ,,; <br /> �rf �. <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE * is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> -1 0 uV x.Ol2�$ <br /> (contract price) (minimum$�0.00) <br /> 2. STATE SURCHARGE **Add the State Bldg Code Div. Surcharge(�linimum Fee of$5.00) <br /> x.0005 $ <br /> (contract price) (minimum$�.00) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ ?.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ <br /> ■ * CONTRACT PRICE or JOB COST 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, labor or installations are furnished by <br /> the 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 permit fee purposes. In the event 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 /> ■ **The STATE SURCHARGE is.0005 times the Contract Price or a minimum of$5.00. <br /> '. �.:; <� '� .� ;.{�,�.�,����'�'AP��.:��AT�€1I�t AfiREE�viEl�iT <br /> The undersigned hereby applies to the City for issuance of a Mechanical Pennit, agrees to do all <br /> work in strict accordance with the ordinances of the City and the regulations of the State of <br /> Minnesota, and certifies that all statements made on this application are complete, true and <br /> correct. <br /> Applicant's Signature: � Date: ��"3��� � <br /> �' <br /> ���'t�'; 3 <br />