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06l14J�011 09:36 S R Mechanical �A�q95293:i148A P.004l007 <br /> P8 ' FE8 ALC A^� ��� (�) <br /> BA+gEI�QF�-2 02 S�:ATE STA <br /> ❑ Yes,chis section appliee <br /> The replecement of a idential fixture or anol,^ce that meets all threa vf the following requiraments; <br /> 1. Doee not require modification w electricai or gas service. <br /> 2. Has a total eose of$500.00 or]ess;g�jy}�j�the cost of the fixture or appliaace:and <br /> 3. Is improved,installed or replaeed by the homeowner or licensed contracber. <br /> Skip nexc section,ifthis applies; Cost of Perrnit S 1�.00 <br /> stete 3urcharge $ 3.00 <br /> Mai1-la Fee(]f Applicable) $ 2.00 <br /> Total Pormit Fee S <br /> PTRMiT FF�CALC�i91'.LATION S' —„�QB,S � $$�Q.00 <br /> If above dooe aot epply;follow guideliQes belaw: <br /> 1. CONTYtACT PRICE *ia 1 Z59�o of aontract price with a(Minimum Fee of 550.00) <br /> 3. ��� x.O1Z5$ � � •� <br /> (contn�ot prlCe) (minimom SS0.00) <br /> 2. STA'r'��URCHARG� � <br /> �- � x.0005 $ � � <br /> (convect price) <br /> 3. P03TAQE&HANDLINQ(Only on�Nlail-In Applications) � 2.00 <br /> 4. TOTAL PERMIT FEE(Add J,inos a-3 Above) S _7 �� � <br /> ■ * CONTRACT PRICE or JOB COST means the actual or estimated dollar emount charged for the <br /> permitted work inaluding materials,lebor.profit�and ot1►er 8xed costs. !t�s the amounc to be cbarged <br /> to the customer for tbe work done. if eny mexerial,equipm�t,Iabor or inatallacions are tluais6ed by <br /> the owner,tenaet or any othe�party,the reasonsble msrket value of auch items must be added to the <br /> estimated cost or co�ntract price for permit fee purposes. ]n the event that there is a diepute on the <br /> amoww��tt of the job aost,the City may request the submission of a s�gned copy of the actual contract. <br /> MFCI�A,NYCAL PERMYT APPLICATION AGREEIV�NT <br /> The undersigned heraby applios to the City for issuance of a Mechanical Permit, agreea to do all <br /> work in strict accordance with the ordinances of the City and the regulations o�the State of <br /> Minnesota, and cactifles that all statament� made on this applleation are complete, true and <br /> correct <br /> . <br /> Applicant's S ignature: � Date: � y`/ �f� <br /> Res�t Forn� <br /> 3 <br />