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, 2 , <br /> 4 fi�.^� `�.�`'� <br /> ti � <br /> � .� 4.*'�N"���*Ey����. <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or anvliance 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;excludinQ 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 /> Total Permit Fee $ <br /> , <br /> ;,. .& <br /> y .�. ,.� <br /> If above does not apply; foliow guidelines below: <br /> 1. CONTRACT PRICE *is 125%of contract price with a(Minimum Fee of$50.00) <br /> IS, q�n x.oizs$ tag " �5 <br /> (conhact price) (minimum$50.00) <br /> 2. STATE SURCHARGE <br /> 15 r a o a X.000s $ -� -�S <br /> (contract price) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ ��R ' �O <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 /> �y� � <br /> T'he undersigned hereby applie to the City for issuance of a Mechanical Permit, agrees to do all <br /> work in strict accordance wit he ordinances of City and the regulations of the State of <br /> Minnesota, and certifes that ;al statements a o this application are complete, true and <br /> correct. <br /> Applicant's Signature: � .Z.1— � �'( <br /> 3 <br />