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03-08—'17 13:33 FROM— 1-906 P0003/0004 F-096 <br /> .;�. X'�,;p'., .:0..,'�. T.I. N $.. <br /> ;i' �;�1'. 7'':�'. :•s r ��...}� f, .i, c •:'e5..`.(!P:r Bj <br /> �`B i n.oi 20 2, xA $ ,. ;,', <br /> r <br /> 0 Yes,this section applies <br /> The replacement of a.esidcntial 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 tot4l cost of$500.00 or less;excluding the cost of the fixture or appliance:and <br /> 3. Is improo ed,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 /> . 1ERNOPPEE:CAI,001:iA,1014 S i'.Q$ QV 0 S 0 0. s:" <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> /)1Z.5.9 x.0125$ 50 .40 <br /> (contract price) (minimum$50.00) <br /> 2. STATE 4URCHARGE 112 5. <br /> • (p 3 <br /> x.0005 $ . <br /> !(contract price) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ <br /> b4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ <br /> 5a <br /> • * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the <br /> permitted work ine$uding materials,labor,profit,and other fixed costs. It is the amount to be charged <br /> to the customer fotf 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 /> • <br /> . .`� :c ?,::':> :'1;.I. .ts <br /> .9H.aSIIGA:, 'I:ER1ytT.VAPp)YO.A1'TON'AG12EE1VIF1NT:!;:`;'a ':�: ::V ;: <br /> The undersigned herby 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: C ( 7 <br /> 3 <br />