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05-19-'17 09:08 FROM- T-228 P0003/0004 F-495
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<br /> .. PERMIT�Efi'CAY;C�.A,�TXON � ,., .,., .
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<br /> ;:•.:: . :..::::.. . ;BASED,.OFF::;;�2002 SxATfi�...�;. � ;�:;;:`:;�..�
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<br /> ❑ Yes,this section applics
<br /> The rtplactment of a Residential fixture or aupliance that meei3 all thrcc of the foIlowing requirements:
<br /> 1. Does not require modification fo electrical or gas service.
<br /> 2. Has a total eost of$500.00 or less;excl�the cost of the fi�tture or applianee:and
<br /> 3. rs improvzd,installed or replac�d by thc homeowner or licensed contractor.
<br /> Skip next section,if tliis applies; Cost of Permit $ 15.00
<br /> State Surchargc $ 5.40
<br /> Mail-In�'ee{Tf Applicable) $ 2.00
<br /> Total I'ermit Fee $
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<br /> ;::: • ;..�.;�;:,. ERIVIIT;�EE.CA�;GC7�;ATrON S�='�Q$S:O.�R`$5 0:00':-�:':,,,�...�:.;;�,,..', ,.,;:.,
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<br /> Yf above does not appl�;follow guideIincs bclow:
<br /> 1, COI�i'1'RACT pRYCE * is 1.25%of eontract price wikh a(Mini[x�um�ee of 550.00)d$
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<br /> x.0125$ /IV'
<br /> ( nuact price) (minimum�'SO.QO)
<br /> 2. STAT�S�JRCHA,�t�� (�
<br /> � x.0005 $ /• �
<br /> COatraCt prite)
<br /> 3. pOSTAO�s&HANDLING(Only on Mail-In Applications) $ ����
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<br /> 4. 'r0'Y'A�.P��tMIT��E(Add T.ines i-3 Abo�ve) $ ; �'✓I '
<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, Tt is the amaunt to be charged
<br /> to the customer for thc work done. If any material,equipment,labor or installations are furnished by
<br /> the owner,tenant or an�oYher party,the reasonable market value of such items must be added to the
<br /> estirnated 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 af a signed copy of the actual contraet.
<br /> ' �HA G� :P Rlv1 A�
<br /> �ME NI �; E IT: �LI 'I'X. :A.('x $ME�t ,�
<br /> CA. Q�lr`� R� Tt;;;:;;':',
<br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do alI
<br /> work in strict accordanee with the ordinanees of ihe C' and the regulations of the State of
<br /> Minnesota, and certifies that AII statements made t ' application are cornplete, true and
<br /> concct.
<br /> AppliCant's Signature: DaiC: '"f � /
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