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Jun. 20. 2011 4: 13PM Owens No, 1208 P, 1 I <br /> ,' ' ' ' � <br /> i <br /> . ' <br /> � <br /> ; <br /> � <br /> ❑ Yes,this section applies ; <br /> � <br /> The replecement of a Residential fixt�a�e or sooliaace that meets all three of the�following reqdvanadts: <br /> � <br /> 1. D_og�„g�require modificxtion�elechical or gas service. i <br /> Z. Has e t��c�of 5500.00 or less;�the oost of the fixture or appliarice:and ! <br /> 3. Is improved,installed or replaced by the homcowaer or liceased contractor. . <br /> Skip noxt sc.�tion,if this applies; Cost o�Permit $ 15.00 : <br /> State Swcbarge $ 5•4Q ' <br /> Mail-In Fee(If Applicable) S 2.00 <br /> Total Permit Y+ee S ; <br /> 1f above does not apply;foIlow guidelines below: � <br /> 1. CON7'RACT PRICE *is 1.2s°�of co�ect price wit�a�rin�mum Fee or xso.00) • <br /> �� � i x.0125$ �po�.s•l�C3 , <br /> (carmeet pnce) (minimam Ss0.0� • <br /> 2. ST�SURCHARGE �.5�U U � <br /> .�D, �lJl7 x.0005 S <br /> • (co�act piw) . <br /> 3. POSTAGE&HANDLING(O�ly on Mail-Jn Applications) S 2-00 ' <br /> 4. TOTAL PERMT!'FEE(Add Lines 1-3 Above) S ��•'� o�_��'i�� <br /> ■ * CONTRACf PRiCE or JOB COST meaos the actueJ or estimated dollar emount charged for the � <br /> permitted work uacludiaag u�aterisls,lebor,profit,ead other fixed costs. It is the amount to be cherged , <br /> to the customer for the work done. Tf arry materisl,equipment, labor or instaUabious are furnished by � <br /> tbe owaer,tenant or any other pairty.tbe reagonablc market value of such items must be added tc thc <br /> esdmaud cost or cortract price for permit fee purposes. In the event that tbere is a dispute on the <br /> � amount of the job cost,the City may request the 8ubmission of a sigaed copy of the actuat co�atract. <br /> The undersi�aed betcby applies to the City for issuance of a Mecbiaaical Permit,agrees to do all : <br /> work in shrict accordance with the ordinances of the City sad the regulations of the State of <br /> Minnesota, and certifies that all statemeats made on this applicatio�n are complete, �ue and . <br /> corirec� � <br /> Applicant's Signature: Date: � � <br /> 3 <br />