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, 0�-29-'14 16:47 FROM- T-985 P0003/0004 F-089 <br /> i <br /> � <br /> I <br /> t <br /> S 4 �3 � A ` <br /> 7 '.� b� � <br /> ❑ 'Yes,this section applics � <br /> Thc replacement of a keside tia � e a liancc that mcets all tihrce of the following requirements: � <br /> s <br /> 1, �oes not requirc modification to electrical or gas servicz. � <br /> 2. Has a totsl cost of$500.00 or less;zxcludintr the cost of the fixture or appliance:and • <br /> 3. Is improved,installed or rzplaczd by the homeowner or licensed contractor. � <br /> i <br /> Skip next section,if this applies; Cost of Permii �._ _l 5.Qb � <br /> , <br /> State Surcharge $ S.OU <br /> Mail-1n Fee(�f ppplicable) S 2.OD ` <br /> Total Permit 1Fee $ `it <br /> �,. . fd c J �.. . a'"R^""''�, 'Q� (�' � Af'� r;!.S"` 4, { <br /> ,Y�� 'k 1 ;�t'. @ � n�`i /e''�i. �` f !,C{lS �. a �a�. �1 �''p.�,f'�� � y��� d�~. <br /> .�,5'1�$F�.;1'„�lt.�lV.t.�',�c9 :.��;1.I�•"J7� `li�:. �j`t��.�' .t-\+?�.J,✓�i,�? ��1�,4C�t� ,�.[�Y_)_.VO'�tNit�!f.J;�'i'.!!.W`/t�l!..4�...irf ,� <br /> If above daes not apply;Pollow guidelines below: <br /> 1. CON'TRACT pYt�C� *is 1.25%of contract pricc with a(Minimum Fee of$50.00) <br /> ���. �� x.0125 $ � <br /> (conaac�price) (minimum 550.0�) <br /> 2. STA1'E S1IRCHARG� �l ���'^ �t,� 'l � <br /> "� J� x.0005 $ � 1 � <br /> (ContraCt priCe) <br /> 3, pOSTACrE&�ANDLING(Only on Mail-In Applications) $ Z.00 � <br /> � � <br /> 4. TOTAL P�RMCT�'��(Add�,ines 1-3 Abovc) S � �� � � <br /> � <br /> � <br /> ■ � CONTRACT p�GB or 10B COST means the actual or estimat�d dollar amount charged for the <br /> permitted work including n�aterials,fabor,profit,and other fixed eosts. It is the amount to be charged i <br /> to thc customcr for th�work done. Yf any material,equipment, labor or installations are furnished by j <br /> the owner,tenant or any other parry,the reasonablo market value of such items rnust be added to the f <br /> estimated eost or contract price for permit fee purpos�s. In the evznt that there is a dispute on the i <br /> amount of the job cost,the City may requost the submission of a signed copy of the actual contract. ? <br /> ! <br /> i <br /> ���eCM�� �..t%��: IM �,f�:' .,Y..`'`i .`.FSGF'�i'D�� �: lL' s�l � h.�:'d'�S<d.,ia�'�•,'U,.�.�9, '( <br /> The undersigned hereby applies to the City for issuance of a Moehanical Permit, agrees to do all <br /> work in strict accordance vvith the ordinances of the City and the regulation3 of the State of <br /> Minnesota, and certifies thxt all stat�ments made on this application are complete, true and <br /> corrccC. <br /> Applicant's Signature: Date: � `"l / <br /> 3 <br />