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01-09-'18 14:13 FROM- T-386 P0003/0004 F-805 <br /> 1 ` �i` F i [ ` )' ','4,/R5"A ��� l �'V i %•/1 j j d t� i , ?, <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. 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 $ 15.00 <br /> State Surcharge $ 5,00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> • <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> 14171771 <br /> 14tu Dng ��m n u. 1 1 1' <br /> 2. STATE SURCHARGE Q C'CQ <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) ®$ :;;--y'~;1 <br /> 4. TOTAL PERMIT 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 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 /> 1v1G1ANICAL PERIV�I T APRX,GA TSN A�x1VIFsx<„ ;t,, <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 /> t J' <br /> Applicant's Signature: 1 00t0 <br /> 3 <br />