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01-22-'16 13:04 FROM- T-594 P0003/0004 F-970 <br />� <br /> ; <br /> � <br /> � <br /> '�^ '�l.Y ,-__ �t l J.�N�f�.^1^C`Au ll`3C�J��I�J1}��/+�l��'S�1V�U� : -' �\ � ��. I G `� ; ... � <br /> f ��. <br /> ( _ _ _ <br /> �V ` . � �������c������zoo2-rs���'��T�CJ,� �_.�.._= ..� .'� - ,� �v: E <br /> �- T <br /> - � -->�= .� . , <br /> � Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets afl three ofthe following requiremcnCs: <br /> 1, D,�g���ot require modification to eleotrical or gas service. <br /> 2. �Cas a toral of�500.00 or less;excludin�the cost of the fixture or appliance�and <br /> 3. fs improved,instAlled or repl�eed by thc homeowner or licenscd contrACtor. <br /> Skip next section,if this applies; Cost of Permit � 15.00 <br /> State Surcharge $ 5.00 <br /> M�il-In Fee(ifApplicable) $ 2,00 c <br /> Total Permit Fee � <br /> � <br /> � .) �ryry�l/y,. � ��.y ��(/ (�Y1�' <br /> � ' A�.'{�� ._.:.*���^-�1.`_.-'.����M .��� . � '1\N 4�Qo 1./V,•. F ,K `X A �,.%' �", i� <br /> [".;�"^,..:_.,. ..t�,,... ._ _. �.:_(���-����.,(�... ._ �. , ,_..,_.s , s.. ..- s <br /> � _ <br /> If above does not apply; follow guidelines below: � <br /> t <br /> 1. CONTRACT��tYC� * is L25%of contract price with a(Minimum Fee of$50.00) p <br /> (,� � � � <br /> 1 � x.O 1'25$_�� <br /> (contracc price) (minimvm 530.00) <br /> 2. STATE SURCHARGE � ��� <br /> x.0005 �: �� <br /> �( ontractprice) i�y, , <br /> �',�� ,,� , <br /> i � <br /> 3. POSTAGE&HANDLING(Only on Mai1-In Applications) $ � i <br /> , ��j � <br /> l,I� � � <br /> 4. TOTAL PERMIT FEE(Add�,ines 1-3 Above) $�� i <br /> i <br /> • * CONTTtACT P�tCGE or �OB COST means the actual or estimAted dollar a►nount charged for the � <br /> permitted work including materisls,labor,profit,and other fixed costs. rt is the amount ta be charged ; <br /> to thc custorner for the work done. [f any material,equipment, labor or installations are fiurnished by � <br /> the owner, tenani or an�other party>the reasonable market value of such iYems must be added to the � <br /> estimated cost or contract price for permit fce purposes. In the event that there is a dispute on the : <br /> amaunt of the job cost, thc City may requcst the submissipn of a signed copy of the actual contcact. ! <br /> i <br /> � <br /> �� i <br /> �-ar"`�r ,�a'ya �S ��',{� �7�A�' ryq-�F�•�'�£p `, �. �� i L� �v�. �1V.���]�yfL' y�,.�}�.7 .�.t �'•,4 o'`CrY- ; <br /> ��,..f�� _,-�sa,i���Y.tA:'<��:�.�CA�S..�`1,fnd�►.�"��u�. &.. .... r.. R^�:..:.��}'�.,1'.'�,fc'xr..�i tr�..�_�..,_.. <br /> � <br /> f <br /> I <br /> � <br /> The undersigned hcreb� applies to the City for issuance of a Mechanical Fermit, ag►�ecs to do a(1 i <br /> work in stric# accordancc with the ordinances of the City and the regulations of the SCaCc of , <br /> Minnesota, and certifies that all statements made on this application are complete, true and <br /> co�rect. <br /> Applicant's Signature: �"'��!��U��� Date: ! ��_�� <br /> 3 <br />