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03-16—'17 09:28 FROM— T-929 P0003/0004 F-126
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<br /> ❑ 'Yas,this section applies
<br /> Tho replacement of�Ctesidential fixture or appliance that meets all th['�e of the following requirements:
<br /> 1. Doos not require xtlodification to electrical or gas service.
<br /> 2. Has a total cost of$500.00 or irss;excludine the cost of the fixture or appliance:and
<br /> 3. Ys improved,instailed ar replaced by th�homeowner or licensed eontractor_
<br /> Skip next section,if this applies; Cost of Permit $ IS_00
<br /> State Surcharge $ 5.00
<br /> Mail-In Fee(If Applicable) $ 2.00
<br /> Total PeaTnit�ee $
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<br /> If above does not apply;follow guidetines below:
<br /> 1. CONT1tACT PRICE $is 1.25%of contract prie�with a(Minimum Fee of$50.00)
<br /> J7 a5 7 X.o�zs$ Z 1 � ,��
<br /> (ontreCt priCe) (miniiuum$50,0�
<br /> 2. srAr�S�JRC�YaRG� 1 o 5.-7 3
<br /> x.0005 $ �• �
<br /> (omract pric�)
<br /> 3. pOSTAdE&HANDLING(4nly on Mail-In Appiications) $ �
<br /> 4. TO'K'AX.���tMC'!'FEE(Add Lines 1-3 Above) $ �� � •��
<br /> ■ '� CONTRACT PRICE or JO� COST means the actual or estimated dollar amount charged for the
<br /> ptrmitted work including materisls,labor,profit,and othtr fixed costs_ It is the amount to b�eharged
<br /> to the customer for thc work done. 1(f any material,equipment, labor or instailations are furnished by
<br /> the owner,tenant or any other party,the reasonable rnarket value of such itcros must be added to tl�e
<br /> estimated cost or contract pricc for permit fee purposes. Ir►the evenC that thtre is a dispute on ihe
<br /> amount of die job cost, the CiCy may request the submission of a signed copy of the aotual contract.
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<br /> ll. N..�N.I.'T.�:i�nl./� S�S Ui�:�'�`.
<br /> The undersigned hereby applies to the City for issuanee of a Mechanical Permit, agrees to do all
<br /> work in strict accordanee witl, the ordinances of the City and the regulations of ihe State of
<br /> Minnesota, and certifies that all statements made on this applieation are complete, true and
<br /> conect.
<br /> AppliCanYs Signature: Date: .� r/ C�� / �
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