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. . <br /> '� � �`� �� � �,������ � '� � � o� �.��'� ��� �`�` �� � , � �r�� . <br /> z <br /> �"�� e�` �� -''�' '� � s; � � �� � ���`� � �` * ������� �„�,� ��`; �� � � a� <br /> >'s°:,.,,��� .at.,^ '�,,���,..'� ��s ����e� r�f����.����'��3�,�'�.��€ ': � c �� i� � � _�� . <br /> _ �^ x�.*? r.*' e, <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or a h ce that meets all three of the following requirements: <br /> 1. Does not require modification to electrica r gas service. <br /> 2. Has a total cost of$500.00 or less; excludine e cost of the fixture or appliance: and <br /> 3. Is improved,installed or replaced by the homeo er or licensed contractor. <br /> Skip next section,if this applies; Cost of Pe $ 15.00 <br /> State Surcharge $ 5.00 <br /> . Mail-In Fee(If Ap 'cable) $ 2.00 <br /> Total Permit Fee $ <br /> x �:, rk�a-�T°'',�;�' F�� �t'.�,�����.'��W� 45e ���,�.,�"��,���������.. . ���� � pkv 1„y �,... <br /> If above does not apply; follow guidelines below: <br /> 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> m- _ �D <br /> ������ , x.0125$ �a /, <br /> (contractprice) (minimum$50.00) <br /> 2. STATE SURCHARGE **Add the State Bldg Code Div. Surcharge(Minimum Fee of 55.00) <br /> � �y�Il�(�r `-�"' x.0005 $ II��a <br /> (contractprice) (minimum$5.00) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ ���'� � <br /> ■ * CONTR.ACT 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 /> ■ **The STATE SURCHARGE is .0005 times the Contract Price or a rrin;mum of$5.00. <br /> � ���`'��,��:..,�,_����;�CI�Pa��;AI������,�'��i�A�.fiO�?A�'r��.�NT='� t� �;:.. <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all <br /> work in sirict 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 /> �� � <br /> 7 �''/. <br /> ApplicanYs Signature: Ll�JJ ' °i- : Date: �'"3�'�� <br /> 3 <br />