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j ,11-30-'16 15:12 FROM- T-480 P0012/0016 F-583 <br /> � , � <br /> r ,... _ _ _ <br /> _ _ - _� �d , - - - <br /> d� � " <br /> - - ,�.. . �.�'� .- - .-�'.�= - - ��M� <br /> 0 Yes,this section applies <br /> The replacement of a Residential fixture or appliancc that meets al!threz of the foltorwing requirements: <br /> i. boes not require modification to electrical or gas service. <br /> 2. T�as a tota)cost of$500.00 or tess;excludina the cost of the f'rxture or appliance:and <br /> 3. Ts improved,installed or repla�ed by the homeown�r or licensed contractor. <br /> Skip nzxt section,if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Pee(Tf Applicable) S 2.00 <br /> � Total permit Fee S <br /> �_�; r �� -- ,�. - _ ;� � <br /> Tf abor+e does not apply;follow guidzlines belo�v: <br /> 1. CONTYtACT p�tlC� * is 1.?5%of contcact priee with a(Minimum�ee of$50.00} <br /> ���/� x.012S$ �d� <br /> (contract prico) (minimum$SO.oO) <br /> 2, S'Y'ATE SiJRCHARGE � ���(� I. ��r <br /> x.00OS $ � <br /> {ContraCt p�ke) <br /> 3. POSTAGE&�TANY7T�TN0(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAY.p�RMlf���(Add�.ines 1-3 Above) $ <br /> S ��� <br /> ■ * CONT�tACT PR1C�or 10� COST means the actual or estimated dollar amount charged for the <br /> permitted work including materials,labor,proflt,and other fixed costs. Yt is the amvunt 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 marke#value of such items must be added to the <br /> estimated cosf or contract price for parmit fae purposes_ In the event that there is a dispute on the <br /> amount of thc job cost,thc City may rcquest tht submis3ion of a signcd copy of Che sctual contract. <br /> �. ��,���" •-"_ <br /> :� .,� _�., ?���`�T •��- �•:� .�� �` <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 eertifies that all sCatements made on this applicaCion are complete, true and <br /> correct, <br /> _ i � . ) I/ <br /> Applicant's Signature: Date: + � /ld <br /> 3 <br />