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� ,�4'�. <br /> � Yes,this sxtion appli�s <br /> The repl�cement o'f a itesidential fX�PP�ce that meets a11 three of the foltowing requirements; <br /> 1. oc not�equire mod�ficatioe to electrica4 or gas serviee. <br /> 2, Ha,s a t ta,.�of$500.00 0�lCss;exclu in thC�s4 of the fxtuxe ar appliances and <br /> 3, Is imprOved,installed or replaccd by She hameawner or licensed contrtictot. <br /> Cost of Permit $_ 1� <br /> Skip next Sect�on,if this applies: g� <br /> Statc Surcharge �,�bl�, �� <br /> �ai1-ln Fce(If App� �. <br /> '�'otal Permit Fee – <br /> M <br /> Tf abave does not apply;follow guidelines below; <br /> � �,D�N��C� *is 1.25%of contract pricc with a(1YG�imu�n Fec o#'�50.00) <br /> I �����I�6�A-�ill�l ilq� nl ',�.';:�. .�:f�xh':� <br /> ��t'�b) <br /> ;�COnCC�'[�l�C)' <br /> 2, STATE SU HARGE �� x����:_;���l�� <br /> (ce7tttr�ICt.pCice) <br /> lications) `�'"��"`����"`� <br /> 3_ ppSTAG�&HANDLINC�(Only on Mail-ln App � <br /> ,�:�"�:?-'"•'" ..I�,:�T;?'1'►�. <br /> � .;,.�,. "..:.:� -.;. <br /> a. TaTAL PERMI'�'F�E(Add Lines 1.-3 AbovC) <br /> M * CQNTRAG"f PR1.CE or JOB COS'T me o�th and otha�fixcd costs.dt�Is tho amo nt o bejchargcd <br /> permirted work including Knaterials.I�bor,p <br /> to the custamer for the work done, if�ny material,equipmcnt, <br /> labor or installations �rc furnisfiod by <br /> the owneK,tonant or any othcr party,the reasonable markct value of such items must be added to the <br /> cstimated cost or contCact priae for t�e�uest thcusubm ssion e Caes g ed oopyeof the �ct altcontraet <br /> amount of the job cost, the City may q <br /> lies to thc City for issuance Q'f�1Vtechanical Perrtit,agrees to do al1 <br /> 1'i�e undersigned hercby app' <br /> work in strict accordanee with th��atementsemadet on�thtis ppljcat►on a'et�eompleteC t ct a d <br /> Minn c s o t a, a n d c c rt i f i e s t h a t a l l <br /> correct. <br /> � 1..rx?�rv�c�.�' ���-. ��� �� <br /> 1\pplicant's Signature: �� — <br /> 3 <br />