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<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;exeludine 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 Pernut $ 15.00
<br /> State Surcharge $ 5.00
<br /> Mail-In Fee(If Applicable) $ 2.00
<br /> Total Permit Fee $
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<br /> If above does not apply;follow guidelines below:
<br /> 1. CONTRACT PRICE "is 125%of contract price with a(Minimum Fee of$50.00)
<br /> ��L7 oB� DD X.oi2s$ ��"t`�
<br /> (contract price) (minlmum$50.00)
<br /> 2. STATE SURCHARGE ��D�. �
<br /> X.000s $ 1,3�
<br /> (contract price)
<br /> 3. POSTAGE�F�ANDLING(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 /> pernutted 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 fumished 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 pemut 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 /> 'u.;��� � �` -u e i;;��i�� 2'Mh"�'�,.�k��,+R;�i;..:
<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 certif'ies that all statements made on this application are complete, true and
<br /> correct.
<br /> Applicant's Signature: ��"`�/ Date: ������
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