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<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$500.00 or less; excludine 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 Pernut $ 15.00
<br /> State Surcharge $ 5.00
<br /> Mail-In Fee(If Applicable) $ 2.00
<br /> Total Permit Fee $
<br /> ,�-"�,x��«�.����t �'�,'�'���P�.�1��,� � S �'��`` �,:! ,��".���•,�'�aYi,�.''� ��Sh� �� �� �'��--:s'�� "�,.�,n'.-
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<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 /> 5, 70U� J �
<br /> � X.oi2s $ 7✓, d� �.
<br /> (contract pnce) (minimum$50.00)
<br /> 2. STATE SURCHARGE **Add the State Bldg Code Div. Surcharge(Minimum Fee of$5.00)
<br /> �7, vU� �' X.000s $ �.g� ✓
<br /> (contract price) (minimum$5.00)
<br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 �
<br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ �lp �
<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 /> estimated cost or contract price for pemut fee purposes. In the event that there is a dispute on the
<br /> amount of the job cost, the Ci'ty 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.
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<br /> The undersigned hereby applies to the City for issuance of a Mechanical Pernut, 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 /> . p„ . �
<br /> Applicant's Signature: Date: r ���'1� ��
<br /> � 3
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