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From:7634974263 l0/06/2015 12:15 #022 P.004/004
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<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;excludine the cost of the fixture or appliance:and
<br /> 3. is improved,installed or replaced by ihe homeowner or Iicensed contractor.
<br /> Skip next section,if this applies; Cost of Permit $ I5.0
<br /> State Surcharge $ 1.00
<br /> Mail-In Fee(If Applicable) � 2.00
<br /> Total Permit Fee S
<br /> ._..,:� ;-._� .. .,.. . �.P�T�t�T.:�EE+�,1�...G��:'i'��Jl���'. �,.]Q$�1!C���-���'��,.���;�r���r�r�t..'°
<br /> [f above does not apply;follow guidelines below:
<br /> 1. CONTRACT PItTCE *is 1.25%of contract price with a(Minimum Fee of$50.00)
<br /> ��,j V�.�_ x.0125$
<br /> '(contract price) (minimum 550.00)
<br /> 2. ST,4't'E SURCHARGE
<br /> x.0005 $
<br /> (contract price)
<br /> 3. POSTAGE&HANDLING(Only on Mail-ln Applications) S 2.00
<br /> 4. 'i'OTAL PERMIT FEE(Add Lines 1-3 Above) $
<br /> i-:J * CONTRACT PRICE or JOB C05T means the actual or estimated dollar amount charged for the
<br /> permitted work including materials, iabor,profit,and other fixed costs. It is the amount to be charged
<br /> to the cusromer 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.
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<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 /> t �
<br /> Applicant's Signature:�� ' ' �� Date: � � ��
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