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�ERl�i�' �'E� �ALCLTL�'�'IOIOr(S) <br /> 2002 ,���e �tataaCe ❑ I'es This �eefion�,ppi9es <br /> Tl��r�placement of a�esidential fixture or ap�ance that ineets all three of the fol]owinU requirements: <br /> 1) Does not requir.e modification to elech-ical or gas serviee. <br /> 2) Has a total cost of$500.00 or less; excludin� the cost of the fixture or appliance: <br /> and <br /> 3) Is improved, installed or replaced by the homeowner or licensed contractor. <br /> Skip next section; Cost of Pennit $ ]S.Op <br /> State Surcharge $ .50 <br /> �ail-In Fee $ 1.50 <br /> If above does not apply, follow guidelines below: <br /> �• �on�r�ct�'P'iee* is .0125°io of job wit�h a T!✓�fla����u� Fee of(�35.00� <br /> �-��.cL _� .olzs � .3.5_�� <br /> (contract price) (minimum$35.00) <br /> 2. SY.ate ;��-ci�arg�e. �°k Add the State Buildino Code Division a 1'Viiraannum Fee of($ .5�� <br /> ��'.t<� x .00OS $ �_ �;� <br /> (con?ract'price) (rninimum$ .50) <br /> 3. �"�s�age anet�andiin� (f7fely niai!-irt appdiccatr,'ons) $ �_ <br /> 4. '�'CB��L, ���.�✓I��' ��� (Add Iines 1-3 above) $ .�(�.jJ� <br /> *CONTRACT PRICE�or JOB COST means tl�e actual or estimated dollar amount charged for tne penr�itted worl<including <br /> materials,labor,profit,and other fixed cosCs. It is tl�e amount to be charged to the customer for Yhe work donc.If any material, <br /> equipment, fabor,or insta(lation is furriished by tl�e owrier,tenant or any other party the reasonable market value of suct� items <br /> must be added to the estimated cost or contract price for permit fee purposes. In the event that there is a dispute on the amount of <br /> the job cost,the City may request the submission oi a signed copy of the actual contract. <br /> *'"The STATE SURCI-IARGE is.0005 of the contract price under�1,000,000 or$.50-whichever is greater. For valuations over <br /> �1,000,000 call the Department of Inspectionai Services For the price. <br /> The undcrsigned hereby applies to the Ciry for issuance of a Mechanical Pern�it,a�rees to do all work in strict accordance with <br /> the ordinances of the City and the regulation;of the Minnesota State Buildinb Code,and certifies that al]statements made on this <br /> application arc complete,true and corr ct. <br /> Applieant`s Signature: ' �.^���-�z — Date:�`� a p <br /> � <br /> Approved By: Date: <br /> 3 <br />