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. � <br /> � ;,�+� _ � <br /> ���`��"�'�� � <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appliance 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.�or less;excludinQ 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 Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee S <br /> ' ���.����C�� .. '� -�-, -: a��''' ���� . *,. .; <br /> If above dces not apply;follow guidelines below: <br /> 1. CONTRAGT PRICE *is 1.25%of contract price with a(Minimam Fee of 550.00) <br /> 33�-� X.oi2s$ .�'o.vz� <br /> c��c�►ce) cmi�m�m sso.00> <br /> 2. STATE SURCAARGE <br /> ,3,3vr�. � X.000s $ /.Gs <br /> c���� <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ �3 •�o� <br /> ■ * CONTRACT PRICE or JOB COST means the actual or estimated dollaz amount charged for the <br /> permitted work including materials,labor,pmfit,and other fixed costs. It is the amount to be charged <br /> to the customer for the work doae. If any material, equipment, labor or installations are furnished by <br /> the owner,tenant or any other party,the reasonable market value of such items must be added to the <br /> estimated cost or contract price for permit fee purposes. In the eve.nt diat there 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 /> �����:�,' ` � � �. <br /> T'he undersigned hereby applies to the City for issuance of a Mechanical Pernut, agrees to do a11 <br /> work in strict accordance with the ordinances of the City and the regulations of the State of <br /> Minnesota, and cert�es that a11 statements made on this application are complete, taue and <br /> correct. <br /> Applicant's Signature: ,�...r---�._� Date: J� <br /> �� <br /> 3 <br />