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, � <br /> N�. .�. , . <br /> �T, ._ .,.�... _ _ . . <br /> b. i <br /> + <br /> � . . <br /> d.a:r'. .,. r�..::A�'tt i :,... .�..�*..� .. ..w..��. .., . ,��.�.;•� e�:..e.. . . ... , . .,. . , . � . <br /> ... ...: < . -.e. n, ..�..e:_—r E .�+� ,. �.r� .... �.;;,r.,, <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 /> yyp . H <br /> rv <br /> 'N'. �. GN� . . • _ <br /> T <br /> ' °'b . . .. ' y�`" <br /> ��JF.Y-� « 4'.... �.+a t. vu . r�.�..e .....e�r... .w � .a� �o � .. #: �_ ' ..r ,'� �#� ....._.,. .e.n„+.-c-+9' ?. <br /> C <br /> If above does not apply; follow guidelines below: <br /> 1. CONTRACT PRICE * is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> �� o� <br /> x.0125$ <br /> (contract price) (minimum$50.00) <br /> 2. STATE SURCHARGE <br /> ��C,$� °� x.0005 $ <br /> (contract price) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <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 /> , <br /> . � � � � <br /> � <br /> t � .-��� . �..�. .o� , , :.e,. . . ..�ti: �... .��. , <br /> � .. .,�, � . � � �� �.� _ �,_. � <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, 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 Signatu : Date: �Z /� _ <br /> 3 <br />