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<br /> f:ir���-�.�•r.r`;�� �x "� � B ti .,f^r1 „a` x,„�rt�R 'E` ?.'A*' h x�'9 �25 i . t ���+ �t�� k �, �'.
<br /> ���:'10��6�,a i,a'�'� ��,''^ �`� �a'� �� ����i��� �� � � , t.�� e: i�': �,�`� .�'?� ^,;€ ai�:,c , £'�x��a���.
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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;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� _�
<br /> �`1z4��r�.n'�,.�`�'.�^�` aA:,�" ,aE���.,.. ?""' ��d � .mk+r.� �,� `a�..R<t�a��5s`.�,��,*r�# 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$50.00)
<br /> 3,. �(� � x.0125$
<br /> (contract price) (minimum$50.00)
<br /> 2. STATE SURCHARGE
<br /> x.0005 $
<br /> (conVact 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 contracf 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.
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<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 /> Applicant's Signature: _�/,��/L-cti�s���"� Date: �.s� GS 9� �/
<br /> 3
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