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05-31-'17 11 :41 FROM- T-284 P0003/0004 F-558 <br /> ` '� `�ERMIT;��E�,CA'C,CUL TION S ,;. <br /> ;;,,:;.,. <br /> ,���. � )-�. <br /> ::,� <br /> ��; �b:OFF:'=20'2`S ATE;S'�A`r`CJE:` <br /> S� 0 T <br /> $�. �;� <br /> ❑ Yes,this section applies <br /> Thc rcplaccmcnt of a Residential fixture or a liAnce that meets all three of the foilo�ving requirements: <br /> 1. Doe3 not require madification to electrical or gas service. <br /> Z. �Tas a total eost of$500.00 or fess;exeludin the cost ofthe fixture or appliance:and <br /> 3. Is improved,installed or replaeed by the homeowncr or licensed contractor. <br /> Skip next section,if this applies; Cost of permit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(�f Applieable) $ 2.00 <br /> Tota1�ermit Fee $ <br /> �� ��:.pLRMIT.FEE;CAliCULATION(S.)`��.�OBS;Q'V�1Z..$5.00;00.;;�:��'";;`':";::;::;�:;;:;:�;. <br /> If above does not apply;follow guidelines below: <br /> 1. CO1VT�tA,CT pRYC� '"is 1.25%of contract price with a(Minimum Fee of$50.00) � <br /> / � X.o�zs$ 52. � <br /> ( ntrsC[priCC) (minimum$30_00) <br /> 2. STATE SURCHARGE �� <br /> � x.0005 $ �' <br /> (ontract price) <br /> 3. POSTACrB&HANDLING(Only on Mail-Yn Applications) $ � <br /> �� �� .� <br /> 4. TOTAL PERM�T Y���(Add X,ines 1-3 Above) $ /• � <br /> ■ '� CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for thc <br /> permitted work including msttrials,labor,profit,and other fixed costs. It rs the amount to bz charged <br /> Eo thz customer for the work done. If any material,equipment,labor or installations 1re furnished by <br /> the owner,tenant or any other party,the reasonable market valuc of such items must be added to the <br /> estimated cost or contraet priee for permit fee purposes. Tn the cvent that there is a dispute on the <br /> amount of the job cost, the City may requzst the submission of a signcd eop�of the aetual eontract. <br /> ;.,.;..;•.:.;,.:.: <br /> .;:;:,.�... . . .. . <br /> . . ` :;11!�ECHAI�IIGA.Is;PER1VIITiAPPZ;ICA'Y`�ION�AG��11itENT>;:,`�;`.''r.;:�;;;`.;:.::.::�,'.:;; i` <br /> 'X'he 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 e ity and the regulations of the Sfate of <br /> Minnesota, and certifies that all stateme m e r� this applieation �re co�►plete, true and <br /> co�rect. <br /> Applicant's Signature: - �� - - Date: �f� ��/� <br /> 3 <br />