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Q8-03-'16 10:39 FROM- FIRESIDE T-389 P0003/0004 F-926 <br /> ❑ 'Yes,this section applies � <br /> Tho replacement of a Rtsidential fixture or appliance that meets all three of the follow'rng requirements: <br /> 1. Does not require modi�cation to ttectricaI or gas scroico. • <br /> 2. T�as a tota!cost of$500.00 or less;excludin the cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaeed by the homeowner or lieensed contracror. <br /> Skip next section,if this appltes; Cost of permit $ 15.A0 � <br /> State Surcharge $ SAO <br /> Mail-Tn Fee(Tf Applicable) $ 2.00 <br /> Total Permit�'ee � ' <br /> �. <br /> If above does not apply;follow guidtlints btlow: � <br /> 1. CONTItAC`T pRYC� "'is 1.25%of contract pricz with a{Minimum Fee of$50.00) <br /> � ��•'�D x.o125S �j�. Z� <br /> (onimCi Pr�e) (minimam 550.00) <br />. , 2. STATE SURCHARGG �C�3�]� �� ""��I <br /> � � x.0005 � Z� ' <br /> ��ContrectpriC�) <br /> 3. POSTAo�&�ANb�,TNG(Only on Mail-tn Applications) $ �. <br /> 4. TOTAL PERMIT F��(Add Lines 1-3 Above) � �/• �� <br /> ■ " CONTRACT PR[CE or JOB COST means the actual or estimated dollar amount charged for thz ' <br /> pecmimd work ineluding materials,labor,profit,and other fixed casts. Ct is the arnount to be ehar�ed <br /> to the customer for the work done. rf any material,equipment,labor or installations are furnished by <br /> the owner,teaant or any other parry,the reasonable market value of such items must be added to the � <br /> estimated cost or cantract 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 /> ' " I� ., '��. <br /> � <br /> � <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all i <br /> work in strict accordanee with the ordinanees of the City and the regulations of the State of f <br /> Minnesota, and cerCifies that all siatements made on this application are comptete, true and � <br /> correct. I <br /> � �J� <br /> Applicant's Signature: � �="-`-2�L� Date: � �� <br /> i <br /> 3 � <br /> I <br /> � <br /> � <br />