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03-27-'17 14:24 FROM- T-965 P0003/0004 F-173 <br /> � , r <br /> P. T F, E;C�4T� �C��A'�QN S ,�;; :..;>:: <br /> ERIv�I G ,.( )':'�.. ,:::�.:,;;,,. <br /> ........:......:. <br /> . .. ,..... ; <br /> �r,•.:...: ,.. :. <br /> �.,: :.,: > � .,, :�;:;: ';!; <br /> ;�.... <br /> .T1;' <br /> =�2 02`STATE�S' �;;�:�. <br /> <,'<�' <br /> AS�b'O�'��:'� 0 T `TUE:�;+ -:'� `;��:;.�:. <br /> `'$ .� <br /> ❑ �'es,this section applies <br /> The rzplacement of a Residential fixture or appliance that meets all three of the follo'wing requirements� <br /> 1. Doos not rcquiro modifieaCion to eleetrieal or gas service. <br /> 2. Has a total cost of$500.00 or]css;zxcludin�the cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed eontraeWr. <br /> Skip next section,if this applies; Cost of Pcrmit $ 15.00 <br /> State Surcharge $ 5•00 <br /> Mail-Tn�ee(Yf Applicable) $ 2.Ofl <br /> Total permit�'ee � <br /> "� ;PERIVIIT`FE$.�PiLCUL:AI'10I� S. —�70$S,O�R�`$SQO:QO.;�-:'� ;��;; <br /> If abave does not sppiy;follow guidelines belor+v: <br /> 1. CO1VTYtACT PT�C� *is 1.25%of contract price with a(Mihimwn Fee of$SO.O�g <br /> 3�0 � <br /> x.o�25$ �• <br /> ( ntract price) (miuimum$50.00) <br /> a. S�'AT�SURCHARGE I���� ((-� <br /> r X.0005 $ �• <br /> (c nheCt priCr) <br /> 3. POSTAGE&T-TANb�,TI�TQ(Only on Mail-in Applications) $ ��, <br /> �� <br /> 4. TOTAY.�'��tIV�XT���(Add Lines 1-3 Abovt) $ ��� <br /> ■ '� CONTRACT PRICE or JOB COST means the aetual or esdmat�d doltar amount chargcd for thc <br /> pennitted work including matcrials,labor,pmfit,and other fixed costs. It is the amount to be chargcd <br /> to the customtr for the work done. Tf any mat�rial,equipment, labor or installations arc fumished by <br /> the owner,tenant or an�other parry,the reasonable market value of such itoms must be added to the <br /> estimated cost or contract price for perrnit fee purposes. In the evcnt that thtrc is a dispute on the <br /> amount of the job cost,the City may request the submission of a signed eop�+of the aetual contract. <br /> :MEC�IAIVIC:4L.�BRMIT�A,�►FLY�ATYQ�:�AG�'sEIV1�NT<�.;;;-<`;';; ; - <br /> The undersigned hereby applies to the City for issuance of a Mechanical Pezmit,agrees to do all <br /> work in strict accordance with the ordinances of the Ciry and th� regulations of the State of <br /> Minnesota, and certifies that all statements made on this application are eo�nple[e, true and <br /> correct. <br /> , , I"�� �2.�~�� <br /> Applicant s Signature. Date: � <br /> 3 <br />