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11-11—'14 14:34 FROM— T-174 P0003/4004 F-289 <br /> .E i <br /> h�i �. ,J �. . ��� r y ��. : <br /> � k ,<" '4 ,� ... . . ' { <br /> $ d .�.,. .m q 1 '� k S' ,✓� �:� yu...i:, i,,, n� i <br /> � 'Yes,this section applics <br /> The replacement of a Residential fixturs or�p}�liance that meets all three ofthc following requirements: <br /> 1. Docs not require modificaCion to el�cuical or gas szrvice. <br /> 2. Has a total cost of$500.00 or less;�c,i i�the cost of the fixture or appliance:and <br /> 3. Ys improved,installed or replaced hy the homeowner or licensed eontreeior. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ 5.00 ' <br /> Mail-In Pcc(If Applicable) $ 2,00 <br /> Total permit�'ee $ <br /> •� {�' ..'.t�,y•r..; .c, L 5,.. <br /> 1 � �M1!'r�,� 7 ! .� 4 � .�T.7� i' .e • .� �� <br /> Yl i i T: � I�5 �a �! =>..�: .('B.' .�3r:.)" 1.�1 <br /> I <br /> lf above does not apply;�ollaw guidelines below: • <br /> 1. CONTRACT PRICE ;is 1.25%of contract price with a(Minimum�ee of�50.00) � <br /> �C• � x.0125$ +�� <br /> Con�aCt pf�Cc) minimum SS4.00) <br /> �. srnr�s�u�cr��►��� c-c' �� � 1 �� <br /> 1 -�•' � x.000s � "`I l—�" f <br /> (wntract price) <br /> f <br /> 3. P�STAGL&HANDLING(Only on Mail-In AppliCations) $ 2.00 ° <br /> 2�2- <br /> 4. TOTAC,P�YtMyT���(Add Lines 1-3 Above) $ l �` 1 � <br /> ■ s CONTRACT PRtCE or JOB COST means the actual or estimated dollar amount chawged for the <br /> permined work including materials,labor,profit,and other fixed costs. Yt is the amount to be charged <br /> [o the customer for the work dane. Lf any material,eyuipment,labor or installations are furnished by <br /> thc owncr,tenant or any other party,the reasonable markei value of such items must be added to the <br /> estimated cost or contract price for permit fee purposes. yn the event that there is a disput� on the <br /> amount of thc job eost,the City may request the submission of a signed copy of the actuai contract, � <br /> i <br /> r;��P �. .!����.,,q r ; <br /> � ..Cct f' .�= i `�ir.�`��F?u7'�,3r ;Kl. <br /> ( <br /> � <br /> The undersigned heroby applies to the City fpr issuance of a Mechanical Permit, agrees to do all � <br /> work in strict accordance with Che ordi�anccs of the Ciry and the regulations of the State of ? <br /> Minnesota, and certifies that all statements made on this application are complete, true and � <br /> con-ect. <br /> Applicant's Signature: Date: � 1 ` � ' ( ( ` � <br /> 3 <br /> 0 <br /> 1 <br /> . � <br />