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❑ Yes,this section applies <br /> The replacement of a Residential fixture or a,�pliance that meets all three of the following requirements: <br /> 1. Dces 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 ne�ct section,if this applies; Cost of Permit $ 15.00 <br /> State Swcharge $ 1.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE * is 125%of contract price with a(Minimum Fee of$50.00) <br /> �D I '�, '�d� x.0125$ � '✓� ��a <br /> —�(contract price) (minimum$50.00) <br /> 2. STATE SURCHARGE <br /> �� 2i OC�O x.0005 $ (Q , O� <br /> (contract price) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ -�---�- <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $__ �� � , d�_ <br /> ■ * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount chazged 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 /> 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 /> Applicant's Signature: ��,p1���n Date: � <br /> 3 <br />