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,. ���c�:�E cA;a�� ,,::�c�c����� �� �, <br /> � y � � <br /> � �`�i���"r���"�' ���}{��.�'�`�'�.s�'�1�#�� ^� <br /> 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 /> ,�,..yPEPS:�.t'�� ��,� �� �.�.�'�(��l' ., �=��8�'� � ����� _ �. <br /> ��L ' 't�F�a ���2 <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE * is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> ��QQ�C� x.0125$ ��� <br /> (contract price) (minimum$50.00) <br /> 2. STATE SURCHARGE ����� Q <br /> x.0005 $ ��O� <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 /> : ��HA�TI��L'PERM�T'�`P����:'1'I�}Y�;., .[��a:� N`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 certifies that all statements made on this application are complete, true and <br /> correct. <br /> ' n �/ � pr /�L <br /> ApplicanYs Signature: GL�l� �✓�Z��'�- Date:� � -`"' <br /> ' R`�fi+F��Ft�l`C!7 <br /> 3 <br />