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11-16-'16 09:35 FROM- T-415 P0003/0444 F-506
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<br /> ❑ Yes,this section applies
<br /> Tht replac�mel►[of�t k��idential fixtura or appliance that meets all three of tho following reqt►irementS:
<br /> I. Doas not require modiffcation to cltctrical or gas servicc.
<br /> 2. Has a t�tat cost of$500.00 or less;excluding the cost of the fixture or appliance:and
<br /> 3. Is impro'ved,insialled or replaeed by the homeor�vner or lieensed contirr�ckar.
<br /> Skip next section,if tlais applies; Cost of�e�nit $ 15.00
<br /> Statc S�uchargc $ 5.00
<br /> Mail-In Fco(if Applicable) $ 2.00
<br /> Total Permit Fee $
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<br /> If Above does npt apply;follow guidelinas bclow:
<br /> 1. CON'TRACT pYtYC� �is 1.25%of contract�rice w'lth�(�X�nin�um Fee of$50.00)
<br /> �O t{�
<br /> � 3�. �.oz�s� �wa•
<br /> ContrNet priCe) (ulfoimum SS0.00)
<br /> 2. STATE SYJ�tCHARC� )Jp 2 . ,��
<br /> 'l o ✓ x.000s $ ��y�
<br /> (convacc pr�cc>
<br /> 3. POSTAGE&HANDLTNO(Only ort Mail-Tn Applications) S ��
<br /> ) `o�• 8fi
<br /> 4. TOTAL P�RMIT F��(Add Lines 1-3 Above �
<br /> � * CONTlZACT PItYCE or J0� COS'X' means the actual or estimated dollar amount charged for the
<br /> permitted�vork including��i�terials,labor,profit,and other fixed costs. It is the amount to be charged
<br /> to the customer for fhe work done_ If any mattrial,equipment, I&bor or installations are�urnishe.�l by
<br /> tlxe owner,tenant or any othei•party,the ressonsble mArkeC vglue of such items must be added to the
<br /> estimated cost or oontracC price for perniit fee purposes. Tn the event th�t theN•e is a dispute on the
<br /> Amount of the joU COSC, the City mAy request the submission of a sigited eopy of the actual contract.
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<br /> ��l�k,
<br /> The unde�signed hereby applies to the City for issuance of a Mechanical Permit,&grees to cio all
<br /> �voi�k in strict accordance wiih the ordinances af the City and the reg«Iations of the State of
<br /> Minzaesota, and certifies that all statem nts made on t � application are complete, t�•ue and
<br /> correct.
<br /> Applicant's Signatwre: � Date: �J~�� `"��w
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