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<br /> ��u �" vi��'� �T'�'�7��; � a'�y�+„ �' � - � �`� � aY�i��4"�� � ��.xs�'�^���"i`y�,:�eYe�k�+j
<br /> �irq a�`39��� sk�� tr�;"� s� � � 4. ��, �� ' '�a t��ik�"� Yv�4`�r�r'�<f�r�� ,��i� � s��u � nh�4,
<br /> s� ���eu � 2�i�', a� ,n ���' w $ � � ti� n7'�t��k ��',1�ii�����'�'�P�S�'
<br /> �g+�,`��r�r,��r15�N�"�' , 7� ��� %�, w ��,, �,'���` ,� �tin�°�d �rP.��! ��+��Y;"'^ �hs �a
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<br /> ❑ Yes,this section applies
<br /> The replacement of a Residential fixture or a�pliance that meets all three of the following requirements:
<br /> 1. Does not require modification to electrical or gas service.
<br /> 2. Has a t cost of$500.00 or less;exclu in 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 Surchazge $ 5.00
<br /> Mail-In Fee(If Applicable) $ 2.00
<br /> Total Permit Fee $
<br /> y�'��Y k ��� ,„. .e;f,yr�Y " ,rW�'i� r sa.'�4� a.s�i��� '+ �a� .
<br /> (r'+u ��i:��C� 34��y"' �k�� :N3+'�� d� ,'h. "�'� �.;�,!� b',.'l3�a +�L'k. ��dll�,_
<br /> If above does not apply;follow guidelines below:
<br /> 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00)
<br /> � �[ �-f�� X.oias$ I 35a,�7�
<br /> ( uact price) (minimum$50.00)
<br /> 2. STATE SURCHARGE �����y�
<br /> 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) $ �`��'�b
<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 /> esrimated 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 /> �^���1 C�,��t�a'� '�j R����:, c'_.�r: o IF`„ �; `'J `�IKl:�� ar , S c,��,
<br /> _r��x�i ",.�!��2,t��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 certifies that all statements made on this application are complete, true and
<br /> conect.
<br /> Applicant's Signature: - Date: �—/� /�
<br /> 3
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