2011-00066 - mechanical - Laserfiche WebLink

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❑ Yes,this section applies The replacement of a Residential fixture or appliance that meets all three of the following requirements: 1. Does not require modification to electrical or gas service. 2. Has a total cost of$500.00 or less;excludine the cost of the fixture or appliance:and 3. Is improved,installed or replaced by the homeowner or licensed contractor. Skip ne�ct section,if this applies; Cost of Permit $ 15.00 State Surcharge $ 5.00 Mail-In Fee(If Applicable) $ 2.00 Total Permit Fee $ 22.00 If above does not apply;follow guidelines below: 1. CONTRACT PRICE *is 1.25%ontr�t��e with a(Minimum�f$50.00) �� x.0125$ � ��,../ (contract price) (minimum 550.00) 2. STATE SURCHARGE **Add the State Bldg Code Div.Surchazge(Minimum Fee of$5.00) ZZ.00 X.000s $5.00 5, oa (contract price) (minimum$5.00) 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) � VV ■ * CONTRACT PRICE or JOB CQST means the actual or estimated dollaz amount charged for the permitted work including materials,labor,profit,and other fixed costs. It is the amount to be chazged to the customer for the work done. If any material, equipment, labor or installations aze furnished by the owner,tenant or any other pazty,the reasonable market value of such items must be added to the estimated cost or contract price for permit fee purposes. In the event that there is a dispute on the amount of the job cost,the City may request the submission of a signed copy of the actual contract. ■ **The STATE SURCHARGE is.0005 times the Contract Price or a minimum of$5.00. The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all work in strict accordance with the ordinances of the City and the regulations of the State of Minnesota, and certifies that all statements made on this application are complete, true and correct. ' � �' l ' ll - Applicant s Signature: Date: IIp,A��,��, f 3