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J <br /> �� �, <br /> ;E`9 �us� <br /> . „_ ..,,a,. . ; ,. . , . <br /> #°�y '" ,:_ ,� �;.,.. ' ����`W�.:� .� . ' <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requirements: <br /> 1. Does 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 next section,if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ .50 <br /> � Mail-In Fee(If Applicable) $ 1.50 <br /> Total Permit Fee $ <br /> ., . �, <br /> % ; <br /> �. ,-f; '• 2 :TQB�:`�J �����,.-� ����: <br /> v 4:� a. � �, � . <br /> If above does not apply;foilow guidelines below: <br /> 1. CONTRACT PRICE *is 1?5%of contract price with a(Minimum Fee of$35.00) <br /> y9oo , oo X.o��S $ (� �� a� <br /> (contract price) (minimum$35.00) <br /> 2. STATE SURCHARGE **Add the State Bldg Code Div.Surcharge(Minimum Fee of�.50) <br /> y�ba, o � X.000S $ a. �5 � <br /> (conuact price) (minimum$ .50) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ � s �a� <br /> ■ * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged 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 STATE SURCHARGE is .0005 ofthe Building Department at(952)249-4600 for the price. <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 /> correct. <br /> Applicant's Signature: � Date:��G�D.j <br /> ,.� �� ����: <br /> ,. ..�t y����_ � � <br /> Pa�� °�' 43rr�s�' <br /> , ,i <br /> � <br />