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. . � <br /> . , <br /> � a �'�`(�� A� �;��i5�, s�p r.. , � �., - - �`'..�-� ���''F,;..:"� £aa�� a���n,x, �{ � � _ <br /> � � � � � ���^Vy'� <br /> .*.t"�5.�Z:. � .,,�����,�'�... � 4m:" .� 4� ' §s4..,.,.,: .:�..: . ,,�f ����f f..y __'�"r �T 1�`t`. <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 elech-ical 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 /> ���# ��� .�r*.� '� .��E � - ��°� ,�'��� � j�.��$5����R_�`�f�0.0�... _.� ' £�,��t <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 /> qS � I . c�c� X.oi2s $ 1 l �I •-7�O <br /> , ,�, (contract price) (minimum$50.00) <br /> 2. STATE SURCHARGE <br /> �, 5 8 ( � o� x.000s $ u ,� <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 far permit fee purposes. ln the event that there is a dispute on the <br /> amount of the job cost, the City may request the submission of a signe�l copy of the actual contract. <br /> - _ {. /4.,' �: <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 /> � � �J <br /> Applicant's Signature: Date:_��`� � <br /> 3 <br />