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� <br /> (�J I Yes,this section applies <br /> � <br /> The replacement of a Residential fixture or appliance that meets all three of the following requireme�ts: <br /> 1. Does not require modification to electrical or gas service. <br /> ' 2. Has a total cost of$500.00 or less;excludine the cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor. <br /> , Skip next section,if this applies; Cost of Permit $ 15. <br /> State Surcharge $ 1.0 <br /> , Mail-In Fee(If Applicable) $ 2.0 <br /> Total Permit Fee $ <br /> If above does not apply;follow guidelines below: <br /> i 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> I � �� x.0125$ 7�d� <br /> contract price) (atinimum$SO.OU <br /> II 2. STATE SURCHARGE ,� <br /> , ' 0�b x.0005 $ 3< UU <br /> � (contract price) <br /> II 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 I <br /> I 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ , Uv <br /> ❑ * ICONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged or the <br /> permitted work including materials,labor,profit,and other fixed costs. It is the amount to be c azged <br /> to the customer for the work done. If any material,equipment, labor or installations are furnis ed by <br /> thQ owner,tenant or any other party,the reasonable market value of such items must be added to the <br /> estimated cost or contract price for permit fee purposes. In the event that there is a dispute n the <br /> a�nount of the job cost, the City may request the submission of a signed copy of the actual co tract. <br /> The ui4dersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to�o all <br /> work �n strict accordance with the ordinances of the City and the regulations of the St te of <br /> Minnesota, and certifies that all statements made on this application are complete, tru� and <br /> correct. <br /> � � <br /> Applic�ant's Signature: Date: � a� S <br /> 3 <br />