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, ,p <br /> ��� � ' TIQN S � � '� <br /> �� � : � � � ) , <br /> , <br /> t * <br /> � � °� � ��D':O�F 2002:_S A�S�'��ITE , , � <br /> � r � � <br /> =a „ � � x t � �� <br /> . <br /> �� � <br /> .x�t..r n\k�'Y "�' <br /> ��. ...5.. �- , <br /> ❑ Yes,this secrion 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 $ 1.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> � Total Permit Fee $ <br /> • :raa��� � r x �� a <br /> . , ;X �� ��P��.tI��EB C�.��A:�IC)�T S �:� �3�:QVER��O�R;UQ� ,r�`:� .,, ,>' 3�: <br /> If above does not apply; follow guidelines below: <br /> 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> . � 1�5. �IU x.0125$ 3�1�- �``) <br /> �(concract price) (minimum$50.00) <br /> 2. STATESURCHARGE <br /> 3��, � ss. w X.000s $ I 5 . �� <br /> (contract price) <br /> 3. POSTAGE&HANDLING(Only oii Mail-In Applications) $ 0 <br /> 4. TOTAL PERNIIT FEE(Add Lines 1-3 Above) $ 5� - �Z <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, ]abor 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 svent that there is a dispute on the <br /> amounf of the job cost, the City may request the submissiori of a signed copy of the actual contract. <br /> =ME�HAI�ZGP�U�.�'��r"��;A�PI.T�����?N'`: .C'�I�EM��TT�...}a. `" '���, ��: � <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 certif es that all statements made on this application are complete, true and <br /> correct. <br /> • � � <br /> Applicant's Signature: �f ���_�( Y�u{ Date: � �" 3 U� � J� <br /> U <br /> 3 � <br />