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03-13—'17 14:20 FROM— T-916 P0003/0044 F-111
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<br /> ❑ Yes,this section applics
<br /> The replacement of a Residential fixturo ar aprliarice that meets sll three of tht following requirements:
<br /> 1. Doas not require modifiestion to electrical or gas serviee.
<br /> 2. Has a total eost of$500.00 or less;exc[udin�the eost of the fixture or appliance:and
<br /> 3. Is improved,installed or reptaccd by the homeowner or licensed contractor.
<br /> Skip next section,if this applies; Cost of Permit $ 15.00
<br /> State Suroharge $ 5.00
<br /> Mail-Tn Fee(Tf Applicable) S 2.00
<br /> Tota!Y'ermit l�ee $
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<br /> If above daes not apply;follow guidelines balow:
<br /> 1. COIVTRACT pIt1C� '�is 1.25°k of contract price with a(Minimum�te ot 550.00)
<br /> . !��� x_Ol2S$ ��JC��
<br /> (contraCt pricC) (mioimum$50.00)
<br /> 2. STAT��LJ�iC�AYtG� rl /}^�� � �'''�.
<br /> �V '7 [� x.0005 $ �
<br /> con�rac�price)
<br /> 3. pOS'rAGE&HANDLING(Only on Mail-In Applications) $ 2.00
<br /> 4. TQTAY.P�RiVIYT���(Add�,i�es l-3 Above) $ ��/ �
<br /> ■ * CONTR.ACT PRiC� or 70B COST means the actual or ostimated dollar amount charged far the
<br /> permined work includin�materials,labor,profit,and other fixed costs_ It is the amount to be cbarged
<br /> to the customer for the work done. Jf�ny matbrial,equipment, labor or installations are furnished by
<br /> the owner,tenant or any other party,the reasonable market�value of such items must be addcd to the
<br /> estimated eost or contract price for permit fee purposes. Tn the evtnt that there is a dispute on thc
<br /> amount of the job cost,thc City may request the submission of a signed copy of the actual contract.
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<br /> The undcrsigned hereby applies to the City for issuance of�NleChaniCal P�rmit,agrees to do all
<br /> work in strict accordanee with the ordinanees of the Cit� and the regulations of the State of
<br /> Mirunesota, and certifies that all�statements made on this application are complet�, true and
<br /> Correct.
<br /> � � � � � �
<br /> Applicant's Signature. . LLL1V.
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