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. . . <br /> � ���'`� ' `��`+ � . � ��' � �" ��"�` F �r�i� <br /> ��'tl A A� '�1- 9 S���e `i 8- g�� �� '� '. � gC <br /> ��: ,�3 ��.. � �� / �; �t. i r�+2 <br /> r <br /> , �.. ' ��� ��� <br /> ; <br /> � ' <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 contractar. <br /> Skip next section, if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee([f Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> �� . ,G t_ .: .� ,.,,. 3 <br /> .:-:. ... ,w.. , ....i.. .��L��.'r: , .��/ .. ,.,� .:,����.� .. � � , f� <br /> _ , ... y.„ ::+ <br /> �.. ��. � <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE * is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> /����� x.0125$ ��rC1V <br /> (contract price) (minimum$50.00) <br /> 2. STATE SURCHARGE ` �j� 5 <br /> / � ��' "U x.0005 $ � <br /> (contract price) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ �a �� <br /> ■ * CONTRACT PRICE or JOB COST means the actual er estimated dollar amount charged fer 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 /> z ��� €��� a; �,� � <br /> _ <br /> , , <br /> ,.... a � <br /> 2� „,,„,. ,.,,,,, .'�` <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: � � � <br /> 3 <br />