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. • <br /> , �, � { �,.� ;�; �� <br /> w � ����. , ��&. <br /> ..: y� .t a� : °� '��`„� }*�,i'��� 'k'�.c:C z'� �. <br /> : � ��Y �= Y�'" .h)�� �� i.M1R��`i�.� '�{°d°' b�l'c'� <br /> kr�'w�':� x� <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or 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 $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> � �:" � M,� <br /> _�� � � x:�� <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE * is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> 86s1 X.oias$ I�� �i� <br /> (contract price) (minimum 550.00) <br /> 2. STATE SURCHARGE � � �� <br /> �b S 1 X.000s $ <br /> (conVact price) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <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 /> permitted 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 permit 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 /> _, � . , � . ,., ... <br /> ;�, _. . .. ;: , <br /> 2s^3 3 � 3,.,�. <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 /> A licant's Si nature: �/ " � � � Date: � d� l� <br /> PP g 7� <br /> 3 <br />