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i �' <br /> ❑ Yes,this section applies <br /> The replacement of a Residential f xture or anufiance that meets ail three of the following requirements: <br /> 1. Do n require modificafion to eIectrical or gas service, <br /> 2. Has a to�l cost of$500.00 or less;�xcladin,g the cost of the�xture or appliance: and <br /> 3. Is improved,instailed or replacad by the homeowner or licensed contractor. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ 5,0p <br /> MaiI-In Fee(If Applicable) $ 2.00 <br /> Totnl Permit Fee $ <br /> If above does nvt apply;follow guidelines beiow: <br /> 1, �C � *is I.25%of contract price with a(Minimum Fee of 550.06) <br /> _ Ch�� 1 l )���C� X.0125$ �L��`I-�/r'J <br /> (contract price) (�nintmnra SS0.00) <br /> 2. STATE Sj�tCHARC�' <br /> �J'�7G.C�.j X.000s � `��f� <br /> (cont:act price) --. <br /> 3. POSTAGE&HANDLING(Onty on Mail-In Applications) $ _�99-' <br /> 4. TOTAI,PERNIIT FEE(Add Lines 1-3 Above) $ �� �j��, <br /> � * CONTRACT PR10E or 70B COST means tha actual or estimated dollar amount charged for the <br /> permitted work including materia.is,labor,profit,and other fixed costs. It is�e amoant to be charged <br /> to ths customer for the work done. If any matcrial, equipment, tabor or installadons 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 cosf or contraat price for permit fee purposes, In the event that there is a dispute on the <br /> amount of die job cost, the City may request the submission of a signed copy of the aetual contract <br /> The undersigned hereby applies to the City for issuance of a Mechanical Pezmit, agrees to do all <br /> work in strict accordance with the ordinances of the City and the regula#ions of the State of <br /> Minnesata, and certif'ies that all statements made on this application are complete, true and <br /> correct. <br /> �.. <br /> �.. <br /> ApplicanYs Signature: c_��l.-i°1-LL.�/� �{,v��t�.C�� , Date: ��l rP .7.-Cil� <br /> 3 <br />