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r <br /> v <br /> 1 � <br /> � „� �r � � <br /> t F <br /> R�, ' n a��� .z�„�"`��� f- r—7 . .y . d a T fi��' a � 2 �iY �� <br /> • :� r �t?.e;,(h`C „.t``'•�` 3�t - .cy r�c i�s � .� �C s � . e�- . <br /> }.z r�,�` �y,`�`-` �3#id.; 'K'1�;1 #' +�'� -71t.� F . :.e � !+�.,�.'+,'_.,�' ,'�e m a,r'� s:v_�'�-.� <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture ar appliance that meets all three of the following requirements: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excludin¢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 $ 15.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee(If Applicable) $ 1.50 <br /> Total Permit Fee $ <br /> . �34+,.r'•�'�i-���',x.'c..�'"� ��X jz.#4� .-J�����,���tr:�.�,�/������� �����t���-��.;�,`xP^� �,'Y,�:i 3 d� f 4 r . - . <br /> If above does not apply;follow guidelines below: <br /> L CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$35.00) <br /> ��� <br /> x.0125 $ <br /> (contract price) (minimum$35.00) <br /> 2. STATE SURCHARGE **Add the State Bldg Code Div. Surcharge(Minimum Fee of$.50) <br /> x.0005 $ <br /> (contract price) (minimum$ .50) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $_ 1.50 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ <br /> ■ * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the <br /> pernutted work including materials, labor,profit, and other fixed costs. It is the amount to be charged <br /> to the customer for the work done. If any material, equipment, labor or installations are furnished by <br /> the 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 pernut fee purposes. In the event that there is a dispute on the <br /> amount of the job cost, the City may request the submission of a signed copy of the actual contract. <br /> ■ **'The STATE SURCHARGE is.0005 of the Building Department at(952)249-4600 for the price. <br /> . ��1%IECHt�C.�.,.1?E�T A�' �ICA�"��1�A•GR�EMEI��= � f <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all <br /> work in strict accordance with the ordinances of the City and the regulations of the State of <br /> Minnesota, and certifies that all statements made on this application.are complete, true and <br /> correct. <br /> Applicant's Signature: Date: C/ v� <br /> 3 <br />