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05-18-'17 15:45 FROM- T-225 P0003/0004 F-492
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<br /> ❑ Yes,this section applies
<br /> The replactmcnt of a Residential fixture or aqptiFtr►ce that meets all thret of the following requirements:
<br /> 1. boes not require modifieation to electrical or gas serviee.
<br /> 2. Has a total cost of$500.00 or lcss;cxcludin�th,e cost of the fixturz or appliance:and
<br /> 3, Xs improved,installed or replaced b�thc homeowner or licensed contractor.
<br /> Skip nexk section,i�this applies; Cost ofParmit $ 15.00
<br /> State Surchsrgt $ 5.00
<br /> Mail-It1�'ee(Tf AppliCablt) $ 2.04
<br /> Total permit Fee $
<br /> PERMI.T;F�E�ALCULA�'YQN' S�"`" O. R" SOOA ��r.`
<br /> -,ro�'s: �r� $ � ,:,.
<br /> If above does not apply;follow guidelines below:
<br /> 1. CUNTXiACI'pYtTC� *is 1.25%of eontract price with a(Miniaaum�ee of 550.04)
<br /> 8`z�q K.a�25$ Io2. `-��
<br /> contact price} (mLfin►um,b^50.Q0)
<br /> 2. STATE.SURCIiARGE ��a � , Q
<br /> x.4005 $ r
<br /> (ContrACE pricC)
<br /> 3. POSTAQB&HANbY.YNQ(Onl�+on Mail-In ApPlications) $� ��
<br /> 4. TOTAL P�Ctri1YT�E�(Add X,ines 1-3 Above) $�• ��
<br /> ■ * CONfiRACT PRICE or JOB COST means the actual or estimated dollar amount chargcd for the
<br /> permitted work including mat�rials,labor,profit,and other fixed costs. Tt is the amount to be charged
<br /> to the customer for the work done. If any material, equipment,labor or iunstallations aro furnished by
<br /> the owner,tenant or any other party,the reasonablc market value of such items must be addrd 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 ttiquest the submission of a signcd copy of the actuai conh'act.
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<br /> ;NlECHA. ..G,�. ��;-FE �`�AY'pY:XC:4TYON��AGr �N1ENT����''�::�->''`:'�',
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<br /> The undersigned hereb�applies to the City for issuance of a Mechanical �ermit,agrees w do a1t
<br /> 'work in striet accordance with the ordinanees of t e CiCy a�r►d Che regulations of the State of
<br /> 1Vlinnesota, and certifies that all statements m n this application are complete, U•ue and
<br /> correct.
<br /> Applicant's Signature: Date: ��/� /�
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