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�!���`��,� A'��+�"S�; <br /> �A.��:4F�`^2C1t}�S"FATE�T'A� ` .. <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or apnliance that meets all three of the followina requirements: <br /> l. Does not require modification to electricai 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 $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> 'I'otal Permit Fee $ <br /> . " R�TT FE�G�i�S•A.Ti#�1*i � ��rR��fl�`ER'SSfl�:p€? , <br /> If above does not apply;follow guidelines below: <br /> ]. CONTRACT PR(CE * is t.25%of contract price,with a(Minimum Fee of$50.00) / <br /> ., = �jC� p�� <br /> � � x.0125 $___��.-� <br /> .contract pnce) (minimum 550.00) <br /> .�!7 <br /> 2. STATE SURCHARGE \� <br /> x .0005 $ <br /> (contract pricc) <br /> 3. POSTAGE&HANDLING(Only on !vlail-In Applications) $ 2.00 � <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) <br /> S /�� � <br /> ■ * CONTRACT PR10E 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 si�ned copy of the actual contract. <br /> ��A�`��AL�aR�1��A��.I��`��'+�!l�+����1��T'�' . `'' <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 certities that all statements made on this application are complete, true and <br /> correct. <br /> Applicant's Signature: , <br /> `�� ��`.�C " { Date: �~�V ��/ <br /> 3 <br />