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/ <br /> �'��I'�' F�E ���,C�,TT..4.'k'���T(S� <br /> �002 �9at� �tateztw ❑�'es 'I'his Sec��on�pp�ie� <br /> The replacement of a F.esidential fixture or appliarice t17at meets aIi three of the following requir�znents: <br /> l) Does not require modification to electrical or gas sen�ice. <br /> 2) Has a total cost of�;�00.00 or less; excludin�; the cost of the fixture or applrance: <br /> and <br /> 3) Is improved, installed or replaced by the homeo�ner or licensed contractor. <br /> Slcip next secfion; Co�t of Pennit $ ]5.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee $ 1.50 <br /> If above does not apply, follow guidelines below: <br /> �. �nnt�s��ct �'P-i���� is .0125% of job v✓a1:li a]@�Fp����i��rn �{ec of��35.�?0} <br /> ��-`��.� � x .0125 � 5 5�.�: <br /> (contract price) (minin�u�r�$35.00) <br /> 2. S�ate Surchara�e. ** Add t�ie State Building Code Divisioll a l��i�aimum �'��,€�6'(� ,�F}} <br /> .� _ <br /> �i�:.:�, - x .000� $ �. c�'� <br /> coni�ract price) (miriimum� .50) <br /> �. �'�5�����r� ���c� ���t�tl�i��� (�rtt��r�zaif-�rt applic�ttz��a�r�s� $ ��" <br /> 4. �'��'�.�, ���;.,'�a��' ��� (p.dd lines l-' abave) �; ��:.�� <br /> �:Oi�;Pcr.C�I'PRICa- or JC�B CQ 7T mc n�tLc �„uai cr stim�ted dollar anlount charge�i for thc pe;mi±ted v,�or}:inciuding <br /> n,aterials,labor,profit,and oChei fixed costs. Tt is Che ainount to bc charged Co tnc customer for thc�vorlc ctone. �f any i��aterial, <br /> equi���ment, labor,or installation is furnished by thc owner,tcnant or anv other party the reasonable market value of such items <br /> xnust be added to the estimated cost or contract price for permit fce purposes. In the evenC tnat there is a dispute on the arnount of <br /> the job cost,the Cit�y may rcquesY the submi;sion oi a sioned copy of t�he acPual contract. <br /> **Ti�ie STF�TE SURCI-IARCB is.0005 of th�contract price under�1,0�Jb,00Q or�.50-whiehever is greater. For o•aluations over <br /> 01,000,000 call the Depar[ment of Inspectional Services for the price. <br /> Thc undersis,rned hereby applies to the City for issuancc of a Mechanical Pern�iY,a,orees to do ai] worlc in strict accordance with <br /> thc ordinances of t:he City and the re�ulations of the Minncsota State Building Code,and cer[ifies that all statements�riade on Yl1is <br /> application are complete,true and correct. <br /> ;� <br /> Applicant's Signature: ' ��.�- -- ,� —�� Date: ����r" i <br /> Approved By: Date: <br /> 3 <br />