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04-15—'16 13:34 FROM— FIRESIDE T-858 P0043/0004 F-297 <br /> ' :y �p'J . • ' , ,:r=r_._. - - .e .. <br /> r � _ _ Zr� �r `.< ?; ',',�' '�. _.ya �� -��-_ _ ��. twW <br /> '`��"'_ .'�a -- __ _ -�Iq�� ?.'s: _ _ ,?f.: _�_'_'�..T, .!''. ._�'Sx=- _�..z„-.�-'�'�a.&x•` s3 <br /> ❑ Yes,this section appiies ; <br /> The replacement of a 12gsidenUal tixture or appliance that meets all three of the following requirements: � <br /> ; <br /> 1. Does not require modification to electrical or gas service. ' <br /> 2. Has a total eost of$500.00 or less;excludina tho cost of the fixture or app(ianee:and <br /> 3. Is improved,installed or repFaced by the homeo�vncr or licensed contractor. <br /> Skip nexC section,if this applics; Cpst of Permit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In��(IfApplicabte) S _?,Q4 <br /> Totai Permit Fec � <br /> � .�: � ',�� (� j /�`/� (�(� b _ _ _ ', <br /> AVF' 't'�:, ' �' '�" '`r.✓•� •:A�F :V?S(7� ?�v�':�..— 'aa..;, _ <br /> f <br /> ! <br /> If above does not apply;foltow guidelines below: � <br /> l. CONTRACT PRICE ' is 1.25%oPcontract price with a(Minimum Fee of 550.00) <br /> �F� �d� i <br /> . <br /> :.� <br /> x.,or�s$ : . <br /> :(ccmtrac,t'price); �(minfmum�So:Oo) i <br /> 2. STATE SCJRCHA,XtC� � � 6 �i1 � <br /> x;:QQ45`�$: i U <br /> (cdiiS�aci,ptica)' <br /> 3. POSTAG�&HANDLrNG(Qnly on Mait-In Applications) ;$.'. '.2:b0'::.;::;'::::.:� <br /> 4. TOTA�,p�YiMX'����(Add S.ines 1-3 Above) $'::..; ` :�`'=�.�•.:.; <br /> � <br /> • � CQNTRwC7' PRICE or JOB COST means the actual or e�Kimated dollar amount charged Por the � <br /> permitted work including materials,labor,profit,and other fixed costs. Tt is the amount to be charged � <br /> to the customer for the work done. Tf any material>equipment,labor or installations are furnished by ; <br /> the owner,tenant or any other party,the reasonable marktt'vslue of such itcros must bc addcd to thc � <br /> estimated cost or contract price Por permit fee purposzs. ln the z'vznt that there is a dispute on tht <br /> amount of the job co�t,the City may request the submission of a signed copy of the actua! contract. � <br /> °� '�_�r _�` :F ���_�_ _ y' - _ .,y� ������151���1�_' 't. _ -�'�L•`�i__ = - � <br /> � <br /> 1 <br /> � <br /> Thc undcrsigncd hereb� applies to the City for issuance of a Mechanical Pexmit, agrees w do all I <br /> work in strict accordanee with the ordinanees of the City and the regulations of the State of j <br /> Minnesota, and certifies that all statements made on t}iis application aro compict�, truc and € <br /> correct, f <br /> Applicant's Signature: � D1tC: � y � i <br /> K/ � <br /> I <br /> 3 <br /> I <br /> , <br /> t <br /> � <br /> I <br /> I <br />