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❑ Yes,this section applies <br /> The replacement of a Residential fixture or ap8liance 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;excl in the cost of the fixture or appliance:and <br /> 3. Is improved,instalted or replaced by the homeownet 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 F� $ <br />, If above does not apply;follow guidelines below: <br /> i. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> �D�� ,(_� x.0125$ S� ' d Q <br /> (con�act price) (minimum SS0.00) <br /> 2. STATE SURCHARGE <br /> 10�� X.0�5 $ � S <br /> - cocnaacs prioe, <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ � J � <br /> ■ * CONTRACT PRICE or JOB COST means the actual or estimatcd dollar amount chazged 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 ate fumished 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 event that 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 /> 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 applicarion are complete, true and <br /> correct. <br /> Applicant's Signature: Date: � <br /> 3 <br />