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12-08-'15 14:41 FR4M- T-473 P0006/0007 F-827
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<br /> ❑ Yes,this section applits r
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<br /> The replacement of a Residential fxture nr��pli�nce that meeu all three of the following requirements: :
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<br /> 1. Does not require modification to electrical or gas service. �'
<br /> 2. Has a total cost of$500.00 or less;g��the cost of the�xture or appliance:and �
<br /> 3. Is improved,installed or replaced by the homeowner or liconsed eontractor,
<br /> Skip next section,if this applies; Cost of Permit $ 15.00
<br /> State Surchargc $ 5.4�
<br /> Mail-In Fcc(if Applicable) $ 2.00 �
<br /> Total Permit Fee $
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<br /> If above does not apply;follow guidelines below� E
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<br /> i. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee oP 550.00) E
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<br /> ,�pn�C��S�PrICG�; y 1ii�iii,�`►fi�lu�i,�Sk.00, �
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<br /> 2. STATE SURCHARGE � � `
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<br /> �(cg�ii[act;pri�);
<br /> 3. POSTAGE&HANDC.IIJCr(On1y on Mail-In ApplicaSions) �,�, ''� �
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<br /> �{. TpTAI,PERMIT FEE(Adci LIneS 1-3 AbovC) r��''``'�'�Tn`t'�,_A:`''�„"``''�F%c+�".i:`^'+ V
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<br /> ■ + CONTRACT PTZTC� or J01B COST' mtans thz actual or estimated doltar amount charged for the
<br /> permitted work'sncluding materials,labor,profit,and other fixed costs. It is the amount to be eharged
<br /> to the customer for the work done. If any material,cquipment, labor or installations are furnished by
<br /> the owner,tonant or any other party,the reasonable market�value of such items must be added to the :;
<br /> estimated cost or contract price for permit t'ee purposes. In the event that therc is a dispute on the ?
<br /> amount of the job cost,the City may request the submission of a signed copy of the aetual eontract. ':
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<br /> The undcrsigned hereby applies to the City far issuance of a Mechanical Fermit, agrees ta do sll ;
<br /> work in stricC acCordance with the ordinanCes of the City and the regulations of the State of �
<br /> Minnesota, and certifias tha# all statements m�de on this application are complete, true and
<br /> correct.
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<br /> Applicant's Signaturc: ';I?�fF?,�'
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