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12-28—'17 12:46 FROM— T-348 PO006/0007 F-759 <br /> t �: }h t• ��"R >t� -C k r"b `gyp ee 11♦ sY e'T i"a' y J P^ n i a '^r• <br /> r � <br /> �}; i i !,0 tr r t ��.4 t �((�lf+�({! �- t.tlt r'i• <br /> / 1 '�1 1�>�. (`/�-�i1,�•,��y�-yUM{;��,Y���i`�I`��j• ���Y{T��tI�`tj Ge 1'F. 1 f'I. <br /> ',k,';.:1;';-:!.',1-02. <br /> ..t �..2.'; - '•;.......'-v r.A.b ir-q k '��y J,,�lo4tr�*7�CC 4?�HM{�ce iii '.',i j + f t' ,0 <br /> ❑ Yes,this section applies <br /> The replacement of a gesidential 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;excluding 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,OQ <br /> State Surcharge $ 5.00 <br /> Mail-L>,Fee If Applicable) $ 2.00 <br /> (�R }�,t�Ey { �/ tr� Totalp[ Permit Feeeet:� �j�( $ <br /> [Ti a�.,�"L��%r �M,W07.0C•',a "ue,$ 111D a.� AL' l!i'�>lA�V^.�'i7+lW�t�°.+�1 C;j1.Vl�y1�'11 .t1!; r.. ,�yMp;. <br /> L'...c_-...._._ � �.. �..�A;,�1�_�s 1. .9:. �az.., <br /> If above does not apply;follow guidelines below; <br /> 1. CONTRACT PRICE 4 is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> Z1f� x,0125$ Vv <br /> (contract price) (minimum S50.00) <br /> 2. STATE SURCHARGE 2.--/j 7I <br /> X.0005 $ <br /> (contract price) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Linos 1-3 Above) $ G-7 act <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 fitrnished 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 /> `t, �<:, 3 A4'04s.01 CIS.iSAt Ff;IC Irlt_ 00'.tj,P RNOu <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 />