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<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 $ 1.00
<br /> Mail-In Fee(If Applicable) $ 2.00
<br /> Total Permit Fee $
<br /> S.� `� k P � �,''. �
<br /> -cv., �� aL.��; �s.�
<br /> If above does not apply;follow guidelines below:
<br /> 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00)
<br /> ��C�C�O °`s
<br /> X.oi2s$ SD
<br /> (contract price) (minimum$50.00)
<br /> 2. STATE SURCHARGE
<br /> OOO x.0005 $ ���
<br /> (contract price)
<br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ --�A��
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<br /> 4. TOTAL PERMTT FEE(Add Lines 1-3 Above) $ �� �O�
<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.
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<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 /> Applicant's Signature: �� � Date: �^ ��" ��
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