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06-30—'16 14:53 FROM— FIRESIDE T-215 P0403/0044 F-728 <br /> � • . <br /> s , <br /> ❑ Yes,this section applios <br /> The replacement of a Residential fixture or appliance that mzets all three of thz following requiremants: <br /> l. . nat require modificaCion to eleeiric�l or gas service. <br /> 2. Has a total cost of$500.00 or less;excludin the cost of th�fixture or appliartce:and <br /> 3. Is improved,installed or replaced by the homeowncr or licensed contract�r. <br /> Skip next seetion,if this applies; Cost of PermiC $ 15.00 <br /> State Sureharge $ 5.00 <br /> Msil-Tn�'�c(Yf Applicable) $ 2.00 , <br /> Total Permit Fee $ • <br /> � s +, . <br /> If aba�ve does not apply;follow guidelines below: <br /> l. CQNTRACT PRYC� � is 1.25%of contract pric�with a(Minimum Fee of$54.00) ; <br /> s�a 3(� ; <br /> Q 8. X.o�2s$ 5 I• ( <br /> ntract pricc) (m3nimam Ss0.00) f <br /> t <br /> 2. S'Y'A'r�SiJRCHARGE Lf,a g. �� � O� � <br /> ri x.0005 $ ° <br /> (�pn�iaCt p[ice) <br /> 3. POSTAGE&�-TANC)�,ING(Only on Mail-Tn Applicetions) $ �"2:4�— ; <br /> 4. TOTAL PERMIT�'��(Add Lines 1-3 Above) S <br /> 5'.3• y� <br /> ■ '� CONTI2ACT PRICE or JOB COST means the actual or esumated dollar amount chasged for the . <br /> permitt�d work including materials,labor,profit,and other frxc�costs. It is tho amount to be eharged ' <br /> to the customee for the work done. If any material,equipment, labor or insCallations are furnished by <br /> the owner,tenant or any other party,the reasonable market valuo of sueh items must be added to the <br /> estimated cost or contract price for permit fee purposes. In the event th&t Chere is a d'lspute on the , <br /> amount of the job cost,the Ciry may request the submission pf a signed copy of the aetual contract. ' <br /> f <br /> - r�y..a n ,r� . S'-- .#�., N�,,.m. ,..Ta, . <br /> 4 <br /> } <br /> 1 <br /> f <br /> The undersigned hereby applies to the Ciry 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 /> . � J ' <br /> Applicant's S�gnature: Date: '��� ` � 1 <br /> � <br /> � <br /> 3 � <br /> f <br /> i <br /> r <br /> I <br />