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11-26—'14 13:01 FROm— T-237 P0003/0044 F-359 <br /> . . <br /> � <br /> � <br /> 1 1 V ) <br /> 1 <br /> a <br /> i <br /> [] 'Yes,this section applies � <br /> � <br /> 4 <br /> Thc replacement of a Residtntial�xtur�or appliance th�t mccts all threo ofthe following requirements: � <br /> 1. e oc require modificasion to electrical or�as servicz. <br /> ; <br /> 2. Has a total cost of$SOO.OQ or less;excludine the cost of the fixture or applianec:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor. <br /> Skip next section,if this applias; Cost of Permit $ 15.00 <br /> State Sureharge $ 5.00 <br /> Mail-!n Fee(1f Applicable) $ 2.00 � <br /> Total Permit Foe $ <br /> �1 �' ,p �i.': ,f�S'. � h�.'�lA,?. .��3�V'vs=�tf��'k(. '.�� � <br /> i <br /> If above does not apply;follow guidelines below: ' <br /> 1. CON'CRACT PRICE �`is 1.25%of contract price with&(Minimum Fee oi$Sfl.00) � <br /> (� <br /> � (�� X.oiasa ��� <br /> (contract prica) (minimum SS0.00) <br /> 2. STATE S�RCC�ARCE L--� f �J�� � <br /> `� `�` x.0005 $ � � ! <br /> (contract prico) ; <br /> 3. POS'CAd�&C�aN1��.�NG(Only on Mail�Yn Appiications) $ 2.00 � <br /> r �,,� <br /> �.�� � <br /> 4. �'O'CAC.P�rtMIT���(Add I.ines 1-3�bove) $ � � <br /> • * CONTRACT PRICE or JOB COST maans the actual or estimated dollar amount charged for the � <br /> permitted work including materials, labor,profit,and other fixed costs. �t is the amount to be charged ; <br /> to the customer for the work done. Cf arty material,equipmcnt, labor pr installations arc furnished by <br /> thc owncr,tenant or any other party,fhe rtasonable market Value oPsuch items must be added to the <br /> estimated cost or contract price for permit fee purposes. In the event that thzre is a dispute on the <br /> amount of the job eost,the City snay request the submission of a signed copy of the actual eontract. � <br /> , n ;+ �r �T ,.� i <br /> 2i�. _ ..�.'� u �Y 'a'`�,� '.�Rl� ,F ,.�: 'z� ,d+:l;`�����:���� .3+;�7 ,�1 j <br /> The unc3er3igned hereby applies ta the City for issuance of a Mechanical Permit, agrees to do all <br /> work in sCrict accordanCc with thc ordin�nces of the City and the regulations of the State of <br /> Minnesota, and certifies that all statements madC ort this application are complCtC, true and <br /> correct. <br /> ������-� l��l�.( f� <br /> AppliCant's Signaturc: Date: <br /> 3 <br />