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04/06/2016 wE� 18: 57 FAx 612 822 5a08 A1' e Kaeter plumbimg �JOOa/OOa <br /> . <br /> I � <br /> I <br /> . <br /> i ❑ Yes,this scction applies <br /> I Thc rcpiacement of a Residential fixture or_a�aliaar,g that meets all three of thc following requiremenu: <br /> 1. Does not roquire modification to electrical or gas serviee. <br /> I 2. Has a total eost of$500.00 or less;exclud�ina the cost of the fixture or applianee:and <br /> i 3. is improved,installcd or replaced by the homeowner or licensed conbractor. <br /> Skip next section,ifthis applies; Gost af Pcrmit S 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-ln Fee(If ApplicAble) S 2A� <br /> '�otal�ermit Fee S <br /> If above does not apply;follow guidelines below; <br /> 1. CONTRACT PRTCR *is�.25°h of contract pricc with a(Minimum Fee of$50�00) <br /> 3000 x 01�5$ 50min , <br /> . (Contraetpricc) (minimum S50.00) <br /> 2. STATE SURCHARG� <br /> 3000 x.000s s�.5 <br /> c�o����� � <br /> 3_ POSTAGE&HANDLING(Only on Mail-In Applications) $ � � <br /> �}, 'J� <br /> 4. TOTA,�P��T k'�+E(Add Lines I-3 Abovc) $5�' � J <br /> ■ • COIV'TRACT PRICE or)OB COSr meens the actual or esti�r►ated dollar amount chsrged for the <br /> permitted work includin�materials,labor,pro�it,and other fixed eosts. It is the smount to be chargcd • <br /> to�he castomer for the work done. If an�y nna#erial,equipment,labor or installations are fumished by <br /> the owner,tcnant or any other party,the reasonable market value of such items must b�added to the <br /> estim�ted cost or contract price for permit fec 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 signr.ef eopy of the aetual co�tract. <br /> The undersigned hereby applies to the City for issuanCe of a Mechanical Permit, agrees to do all � <br /> work in strict accordanee with the ordinanees of the City and the regulations of the State of } <br /> Minnesota, and certifies that all staicmcnts made on tl�is application aze completc, true and � <br /> correct. I <br /> . A,pplicant's Signature: Date: 4/�/1� <br /> s <br /> 3 � <br /> i <br /> I <br />