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�`� �, �����"��E��I���"�'�C,;��7C��S,ATI�3�T(��' � �° `'� '> ; <br /> ; �: � � �_. � <br /> � � <br /> .�,, : ' � � � �'��A���+�'���2��1�`�'TE S'�� �;, *�� :� � �' <br /> . „ <br /> . . .. r ,�- x a ,. . ,. . <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or a liance that meets all three of the following requirements: <br /> 1. Does not require modification to ele ical or gas service. <br /> 2. Has a total cost of$500.00 or less; exc in the cost of the fixture or appliance: and <br /> 3. Is improved, installed or replaced by the h eowner or licensed contractor. <br /> Skip next section,if this applies; Cost of rnut $ 15.00 <br /> State Surc ge $ 5.00 <br /> Mail-In Fee Applicable) $ 2.00 <br /> Totai Permit Fee $ <br /> .� � .: �P�� ,° �_ ��c=��r�.�:��o����'-,. ����` _�vE���:�o�oo v:, . . .��� � .`.�:�% <br /> If above does not apply; follow guidelines below: <br /> 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> �d+ 5 d�� � x.0125$ >�� �� <br /> (contract price) (minimum$50.00) <br /> 2. STATE SURCHARGE **Add the State Bldg Code Div. Surcharge(Minimum Fee of$5.00) <br /> �a, s�o� � X.0005 $ �, �s <br /> (contract price) (minimum$5.00) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> �D <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) g / ��, <br /> ■ * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the <br /> pernutted 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 market value of such items must be added to the <br /> ' estii:zated cost cr contract price for pemut 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 STATE SURCHARGE is .0005 times the Contract Price or a minimum of$5.00. <br /> ��.� ;;�,,,,,; �, �:� 4�i��f�`I�BI�.A�L;�:���'��'�.3C��v^r�T�AG3:2T�E,"l�,N�'' � � <br /> � <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 /> A licant's Si ature: ', • <br /> PP gn �-- ✓ r Date: �'Jo�� �y <br /> 3 <br />