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. <br /> . ;, <br /> �#4.,r�t ��'.t ''i+, c ka �,�'' �`xs M "��ye� �'y '.' x£z..- . � �k �c�.s�� ;�a,�.,3r4P..�*��+z�'$�' M�R,�*�t r��i�X��1�e�"���,.�. <br /> �`'a��;����'x� ����".zr �>a�t� ,�y�k.t k�'' a �r '�i � x ��«+'��u"1 �c+�:�� ��s ��x � .� � �' : �� +��� F Na„�i ���� -�. <br /> �(��.'� ;�. s r �K..��h�. �::'�,:.�- �����������,�,',' �'�� �fJ ����.Z"J..*�' i 3" " �{"tw� :w{7*�YG"�C�' ��'��-�=�� <br /> e�t -'� � 'ah�"�� � :a� ' $ . t � r <r. .+;f�.�*7�r� � 'k�.,. r.i �" <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;excludin�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 $ <br /> �� �s �r_`��_ ��, ��-����.�'� � �.� �� ��:" �"���;�0����`���k.���t�.�..���,. <br /> If above does not apply; follow guidelines below: <br /> 1. CONTRACT PRICE * is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> �� , s�i 0 x A125$ <br /> (contract price) (minimum$50.00) <br /> 2. STATE SURCHARGE <br /> x.0005 $ <br /> (contract price) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ <br /> ■ * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged 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 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 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 /> � � '�� � �i��1t"��;� _ 7�1 7�7'� � ����,� m 't 4 7�'�'r�� "�{���. ,;., ?k' . <br /> .:���, :p '; .� ' �: ��_:.,� '��,,'f..C+LJ' `;,_ ���". .".�.,�Si'�'krT. ,�f?.�-? <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 /> conect. <br /> � - � - I� <br /> Applicant s Signat re• Da� <br /> 3 <br />