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03-30—'16 13:56 FR4M— FIRESIDE T-841 P4003/4047 F-228 <br /> , , , <br /> _ � _ <br /> ; <br /> =s " - - �= _.�t..: ; <br /> � <br /> ❑ Yts,this section appiies <br /> 'C'he replacernznt of a Ttesidential ftxture or ap�liance that meets all three of the fallowing requiroments: i <br /> 1. Doos not require modification to electrical or gas service. � <br /> 2. Has a total eost of$500.00 or less;excl i the eost of thz fixture or appliance:and <br /> 3. Ts improved,installed or replaced by the homeowner or licensed conhactor. <br /> Skip ncxt section,if this applies; Cost of Permit $ 15.00 <br /> St�te Surcharge $ 5.00 <br /> Mail-in Fte(If Applicable) $ 2.00 <br /> Total Permit Fee $ � <br /> � <br /> ---��= -�-- � "-- _�:: -_ _ _ _� r�. — - _7�� �--- ': <br /> - 1! <br /> 1 <br /> � <br /> 1 <br /> Tf above does not apply;follow guidelines below: � <br /> , <br /> I. CONTI2AC1 PRYCE +is 1.25%of contract price with a(Nlinimum�ee of$50.00) 9 <br /> � jZ�l�" `X`.oizs:$.:� �:7�':�� - <br /> ,.. .. . .. . <br /> . :::.:...... :... <br /> ,. .:, <br /> :,cob�taC�Pri�e3 . � i(mibiqipm:SSO:QU)` <br /> 2. STATE SURCHARGE / JZ G� � <br /> t0/ o x:;o0o5.:$^`,� , <br /> ,(corittact p�icr) � <br /> 3. POSTAGE&HANbLINO(Oniy on Mail-Tn Applications) �$,. _�i0��;'�'`.'`>�`_�:= � <br /> .:�. �..,�J:1.,. �C'T' <br /> 4. TOTAL PERIVIIT FEE(Add Lines 1-3 Above) ::S'��,'-:���': ;::•.�:�::'."::�':�.;':�� <br /> ; <br /> ■ * CONTCtAC1' PRTC� or ]pB GOST means the actuai or estin�ated doilar a,nount chargod for the � <br /> permitted work including materials,labor,profit,and other fixed costs_ It is tht 2mount to be charge8 E <br /> to the cusYomer for the work done. If any material,equipment,labor or installations arc furnishzd by t <br /> the owner,tenant or any other party,the reasonabie market value of such iterns rnust be added to the � <br /> estimated cost or contract price for permit fee purposes. In thc cvont that there is a dispute on the 5 <br /> amount of the job cost,the City may rcquest the submission of a signed eopy of the actual con�act. ; <br /> I <br /> I <br /> x� - t, x,; — = _ - I <br /> � �.n�:�� ------ <br /> � <br /> � <br /> � The undersigned hereby applies to the Cit� �or issuance of a Mecl�anical�ermit,agrees to do all . <br /> work in strict accordance with the ordinances of the Ciry and the regulations of the State of <br /> Minnesota, and certifies that all statements rnade on this application are complete, true and <br /> correct. <br /> Applicant's Signature: �_ �_,,,_, '�Date;.:.� ��/ /� <br /> 3 . <br />