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�'ER�IIT` �A�T.CtT,�.�A.TI�IN��} <br /> BASE�4FF���3T.1�'�'�,��'A'l'{�� <br /> ❑ Yes,this section applies <br /> T'he replacement of a Residential fixture or apnliance 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;excludin¢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 Surchazge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> ���`���1��'�•�,.�l�. �� '� �����'��'.��.� <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE "is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> 3y/o-o . v-� X.oi2s$ so.� <br /> (contract price) (minimum 550.00) <br /> 2. STATE SURCHARGE <br /> 3yvo•c� X.000s $ /,�o <br /> (contract price) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ ,�3.7v <br /> ■ * CONTRACT PRICE or JOB COST means the actual or esrimated 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 mazket value of such items must be added to the <br /> esrimated cost or contract price for permit fee purposes. In the event that tliere 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. <br /> �t��"�'����`��� : ��i�:������I4�'�� ; <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: Jr�-a �----� Date: //�/!o�// <br /> :�L�t fOMrm <br /> 3 <br />