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02-07-'17 14:04 FR4M- T-801 P0403/0004 F-972 <br /> , � <br /> .1 7f 1 i <br /> ❑ Yts,this section applies <br /> The replacement of a Residtntisl fixture or�ppli�ncc tllat rn�ts sIl three of the folloWing requiremenks: <br /> 1. 17oes not require modification to electrical or gas service. <br /> 2. Has a total eost of$500.00 or lcss;excludin�the cost of the fixture or applianee:and <br /> 3_ Is improved,installed or replaeed by the homeowner or licensed contractor. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $�5,,_,Qp <br /> Mail-Yn pee(Yf Applicab[e) $ 2.00 <br /> Total permit�'ee $ <br /> � � � .ldsf,l�Y3�Fi.i� '. � g .1 �k. ,bA -��.- '1�.5����� . <br /> If above does not apply;follow guidelines below: <br /> 1_ CONT�iACT PR�C� *is 1.25%of eontrRct prico with a(Minimum�ee of$�0.00} <br /> 1 �.a�2S$ (pD. c g <br /> (contract price) (nlihimum 550.00) <br /> 2. STATE SURCHARGE G1 Q�)� <br /> �D � x.0005 $ � ^ � 1 <br /> (ContYACt pricc) <br /> 3_ PQ$'Y'AGi�&HANDI.TN�C�(Only on Mail-In Applications) $� <br /> �] 5'� <br /> 4. TOTAL PERMIT�'EE(Add Lines 1-3 Above) $ �C. " <br /> ■ * CONTItACT PRTCE or JOB COST means the actttal or estimated dollar amount charged for the <br /> penmitted work including rnattrials,labar,profi�,snd other fixed costs. Tt is the amount to be charged <br /> to the customer for the work done. If any material,equipment, l�bor or instatlations are fumishcd by <br /> the owner,tenant or any other parry,the r�asonable market va[ue of such items must be aQded to the <br /> estimated cpsk or contr�ct pCiCe for permit fec purposas. In the event that there is a dispute an Che <br /> amount of the job cost, the City may request she submission of a signed copy of the actual eontraet. <br /> • _ y�. .. f...v.. ... ..�.�'y N` ��Y <br /> ��t . ��.y+.�T�{�����yyy[�M <br /> � ' . .iS. ���...t :... '.+idY ..ii"K�TlCt.�.. j�� . S • <br /> .a .�. .�'[��. ..�x ��*' � <br /> The undersigned hereb�applies to the City for issuance of a Mechanical permit,�grees to do all <br /> work in strict accordance with the ordinanees of the City and the regulations of the State of <br /> Minnesota, and certifies that ail statements made on this application are complete, true and <br /> correct. <br /> Appl'rcant's Signature: at�: �r I ~( � <br /> 3 <br />