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. <br /> PER�±lI'I'�'E.��AL�UI.A:TIC}1��5) <br /> BASEI�+I�FF-ZE�`STAk`i'��'�A'�`[.IE ; <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requirements: <br /> 1. Dces not require modification to electricat or gas service. <br /> 2. Has a total cost of$500.00 or less;exclu in 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 /> , ��,�I'I`����1�.��.1���� � -��'�����`r;���, �, <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> �J�Q X.0125$ <�� d .� <br /> (contract price) (minimum S50.00) <br /> 2. STATE SURCHARGE / <br /> /D ` C.�Z� x.0005 $ � • � � <br /> (contract price) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ � b J . `(� <br /> ■ * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the <br /> permitted work including rnaterials,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 mazket 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 /> 1V�GH1'�ICA�.,��R�I`T'A�'P����4�'����� <br /> The undersigned hereby applies to the City for issua,nce 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 /> Applica.nt's Signature: � Date: ` � � / � <br /> 3 <br />