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05-05-'17 11 :15 FROM- T-167 P0003/0004 F-416 <br /> " <br /> i L' 1V1�1 f7 <br /> ,n�5'y_,1 r �i�<� �I �'� G�,t✓ 7A r 1,(; <br /> U, <br /> !., LY r� dti r.r.� sD,QFy ZV,� .Sl"Ali'r�17S ;"l� 1 &r t+ CSt � s rrrtid.,.< <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. Hasa total cost of$500.00 or less;excl�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 Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> .1 `"..°FERMr 'FB>✓; Y:( AT 2j�(;,) '�0 4`V;E; 1500, <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> �Q x.0125$ Oki- GG <br /> (c ract prlCe) (minimum$50.00) <br /> 2. STATE SURCHARGE f_, [ <br /> x.0005 $ <br /> (p ntraet price) /�� <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ ��v v <br /> 4. TOTAL PERMIT EEE(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 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 /> MEC1W. OMIT ARR om,;-, GREEM�rrr M.,: ,1, <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 is application are complete, true and <br /> correct_ <br /> Applicant's Signature: Date: <br /> 3 <br />