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05-17-'17 15:26 FROM- T-218 P0003/OQ44 F-484 <br /> " �, <br /> �. <br /> ❑ Yes,this section applies <br /> The replacement of s ltesidential�xtu��r appliance thAt meets all three of th�followi�requirements: <br /> 1. Does no require modification to eltctrical or gas scrvice. <br /> 2. Has a tal cost of$500.00 or less;exeludin�the cost of the fixturo or applianee:and <br /> 3. [s improved,instAlled or replaced by the homeowner or licensed contractor. <br /> Skip ncxt section,if this applies; Cost ofPermit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In�'ee(Tf Applicable) $ 2.00 <br /> Tot�l Permit�'ee � <br /> 4 M <br /> Ifabove does not appl�+;follow guidelines below: <br /> 1. CONTYtACT PRICE *is].25%of eontract price with a(Minimum Fee of$50.00) <br /> 9'!� X_0�25$ , `�`� <br /> (convact priCe) (m n mum$50.00) <br /> 2. S'X'AT�SURCHARGE �9/(� L� � <br /> � �� x.Q005 $ <br /> (contract pricc) <br /> 3, pOSTACyB&HANDLING(Only on Mail-Tn Applications) $ t/.88'� ��� <br /> /�f �� <br /> 4. TOTA,X.���tMIT TEE(Add Lines 1-3 A'bove) S <br /> ■ * CON'X'ItACT PRICE or JOS COST means the actual or estimated dollar amount charged for tl�e <br /> pennitted work including maCerials,labor,profit,and other fixed costs. It is the AmounC to be eharged <br /> to the customer for the�votk done. Tf any rn�terial,eqtupmenC, lttbor or instttllations are furnished by <br /> tho o'umer, tenant or atly other party,the reasanable market value of such rterr►s must be added to the <br /> estimated eost or eontract price for permit fee purposes. In the event that there is a dispute on the <br /> amou►�t of the job eost,the City may request the submission of a signed copy of the ackual contraet. <br /> , f <br /> The unclersigned hea•eby applies to the CiCy for issuanee of a Mechanical Fe�mit, agrees to do all <br /> work in strict accorda�ice with the ordinances of the Gity and the regulations of the State of <br /> Minnesota, and certifies thaC all statements m n this application are complete, true and <br /> GOrreCt. <br /> Applicani's Sagnature� Date: ��� /'�l� _ <br /> 3 <br />