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� � <br /> � i <br /> r �� ° a'�°"� * � • ; � <br /> ��`� �`���-���'�a��i-�� �� .�:�"� « °e„ _..,� <br /> , _ <br /> s a x ; , � � <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requirements: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excludine the cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> �"r„�:��� .�PERML'��E� ��LILL� �C�'� .. i�� . .�$S��',�`R��OO�bO� .. �,� <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE * is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> �Z� 13`�l . ov X.oi2s$ 1s1 � �$ <br /> (contract price) (minimum$50.00) <br /> 2. STATE SURCHARGE 1-Z� � 3`-� Uv x.0005 $ � ' � � <br /> (conuact price) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Appiications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ l✓ ! •� S <br /> ■ * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the <br /> permitted work including materials, labor,profit,and other fixed costs. It is the amount to be charged <br /> to the customer for the work done. If any material, equipment, labor or installations are furnished by <br /> the owner,tenant or any other party, the reasonable market value of such items must be added to the <br /> estimated cost or contract price for permit fee purposes. In the event that there is a dispute on the <br /> amount of the job cost, the City may request the submission of a signed copy of the actual contract. <br /> �.�•.' x ��][A�T� �` � I� (� R�E�1%�E� <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all <br /> work in strict accordance with the ordinances of the City and the regulations of the State of <br /> Minnesota, and certifies that all statements made on this application are complete, true and <br /> correct. <br /> A licant's Si ature: Date: �' � /�Z <br /> PP � <br /> ` � � �A <br /> 3 <br />