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5�:h 5 a ,d9... ts k*<qt��T..�, .r! i� d^ j,;, � P` y,� L t �v s y� ` y '.., . . . ..
<br /> rd �°�,�rb,k ryS,,. `�^�'�•,s1��,a"1, �t t�'�. sF}a°o v� �'`�� x 5����(�.�,;'$I ,a�:hn{�P PY5''�7s y �ry+.a:� a3 j�'y�?t.yv�'�,y N�,,� . ,.
<br /> ;��:y.�a1 "v ..i '�l 4 y M1 ��5�e�i/�n;x ' �k�/�' a w„, z a 41� ��:rt tT d G`k� z�fj+.ti� �t y�kSJ n�.,. .
<br /> '`„� h�15 .,d. 3 �}� d�y S .}.�,�'�C��$�1�.:^'C��T✓+���� ��Y���4£� �'� l,:� 1 F 1 7�.�'� E M1'[�',v��!r�'A ^'t'.y, .
<br /> 0 Yes,this sec�ion applies ,
<br /> The repiacement of a Residenrial fixture or apvlianc�#hat meets all three of the following requirements:
<br /> t
<br /> 1. Does not require modification to electrical or gas service.
<br /> 2, Has a total�_„_cost of$500.00 or less�exc udin the cost of the fixture or appl�ance:and
<br /> 3. Is iz�roved,instailed or replaced by the-horneowner or licensed contractor. '
<br /> ; ,
<br /> Skip next ssction,if this applies; � Cost o�'Permit' $ > 15.00
<br /> � :State SurCharge> $ ':50 '
<br /> ' Mai1-Tn�ee(If Applicable) $ 1.50
<br /> Totai Permit Fee $
<br /> �`X�Yf ..r. t" ��+�3�+i�.!�,����.�*�(.•������� i+j'f, .:r����������>1J ��'iT F �� ir�`f°F.,dai�d�,T>';^r r .,. .....
<br /> If above does not ap�ly;,follow guidelines below: �
<br /> 1. CONT�tACT FRICE *is 1.25%0 of uontract price vwith a(�Vlit�imum Fee of$35.00)
<br /> �/8�r x.0125$ ..�.�'d�
<br /> (Gontract price) (minimum$35.00)
<br /> i,
<br /> 2. STATE SUR�C�IARGE **Add the�tate B1dg Code Div. Surcharge(Minimu�n Fee of$.50)
<br /> �,���� x A005 $ � ��
<br /> , (contractprice) (minimum$ :50)
<br /> 3. POSTAGE&HA.NDLING(4nly on M�ail-Tn Applications) � ' 1.30
<br /> ;
<br /> 4. TOTAL PERMIT FEE(Add Lines 1-�Aboae) $ ��`'�� `
<br /> ! * CONTRACT PRiCE or JOB COST mea�,s�the actual or estimated dollar amount charged for the
<br /> pertnitted work including mate�ials,labor,pro#�t,and other fixed costs. It is the amount to be,chaxged
<br /> to t13e customer for the work done. If any material, equipmeni,'iabar'or instailations are fiunished by
<br /> the owner,tenant oz any other party, the reaso�able market value of such items must be added to the
<br /> estimated cost or contraci price for perrnit fe� purposes. In the event that there is a dispute on the
<br /> amount of Che job cost, #he City may request �he sabmission of a sig�ned copy of the actual contract.
<br /> ■ **Th�STATE S[JI�CHAI�GE is-0005 of the$uilding Department at(952)249-4b00 for the price.
<br /> " ,'� ,1\�EG�CA�.=PER1V��';� ,P�,Z+�A'L`IO1�T°A.GR:��IVIEN'T .�� ''
<br /> , :
<br /> The undersigned hereby applies to the City fou issuance of a Mechanical Perrnit, agrees to do a11
<br /> work in strict accordance with the ordir�an.ce�,of the-,City and the' regula�ipns of the `State of -
<br /> Minnesota, and certifies that all statem�nts rna�ie on tihis application are complete, true and
<br /> correct.
<br /> A,pplYcant°s Sigri�ture: Date: �—o�d��d�
<br /> 3
<br /> � �..�. ;
<br />
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