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ar�4lF "� �e� Y�rk � � .. � .: /1e� � � le.� '�{ r"� � +' s,{��� T. .: <br /> 3' F�d ? k i"•l� S raM.�, 6N `� ����l� ��.:'A�V ������������i' � �. i�y'�. C{' �3`6�Y" 1y{} <br /> ]' x�" �'" R`on ,�- f'"'e�ll s v �'�rsL', � fiy, a kr �� -r �,. <br /> a a�� ,�� i �7�� �,a ar� 7 � � s '�t�1' �n s ���" <br /> �"� �� 9 ��, v,5 S BA.�:SED���� , �fl02,S��A.��£-S�` �.A�'[.T� � T <,:��� , ; ,�,�7 .�,G� a.�:� <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or a�pliance that meets all three of the followi.ng requirements: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excludinQ the cost of the fixture or appliance: and <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor. <br /> Slcip next secrion,if this applies; Cost of Pernrit $ 15.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee(If Applicable) $ 1.50 <br /> Total Permit Fee $ <br /> � �� ,� , ' `F�:R]1l3:"�FE���A�.�.C�.�A'�QrT S). �;U��S 4�R:',��S�O::QQ r ' ,�� d,�� M; � � <br /> ,,;,,v <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE *is 1.25%o co act price with a(Minimum Fee of$35.00) <br /> 01 ��� x.0125$ <br /> (contract price) (minimum$35.00) <br /> 2. STATE SURCHARGE **Add the State Bldg Code Div. Surcharge(Minimum Fee of$.50) <br /> x.0005 $ <br /> (contract price) (minimum$ .SO) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 1.50 <br /> 4. TOTAL PERNIIT FEE(Add Lines 1-3 Above) $ <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 fumished 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 /> ■ **The STATE SURCHARGE is.0005 of the Building Department at(952)249-4600 for the price. <br /> �= �. . �-� ;w: :NI�C�-T�4NTC�,P��I�'ARP�I�AT�O�'t�AfiRLEMENT . � '>;� . . ,..�: „�.,, ;' <br /> The undersigned hereby applie t the ity for issuance of a Mechanical Permit, agrees to do all <br /> work in strict accordance wit e or inances of the City and the regulations of the State of <br /> Minnesota, and certifies that 1 stat ments made on this application are complete, true and <br /> correct. <br /> Applicant's Signature: Date: � ''� � <br /> 3 <br />