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<br /> ❑ Yes, this section applies
<br /> The replacement of a Residential fixture or a liance 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;excludi g 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;
<br /> Cost of Permit $ 00
<br /> _5
<br /> State Surcharge $ 50
<br /> Mail-In Fee(If Applicablg
<br /> ) $� 150
<br /> Total Permit Fee
<br /> •
<br /> 3 � 1 A .�.:,2' N F� .�ai�i rte + [i 7 t�✓V x "' } "pa 2a s., ra a.H,x _
<br /> [A ^W 10.. G �
<br /> '�fa ar-a...mmm� i t+r ar tt:ftd � V k * .! vl� m` ( y r }:, �� '*'p
<br /> If above does not apply;follow guidelines below: ..
<br /> 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee,'of$35.00)
<br /> x .0125$
<br /> (contract price) (minimum 535.00)
<br /> 2. STATE SURCHARGE **
<br /> Add the State Bldg rade Div Surcharge(Mi
<br /> t,ii:r.u4;i Fee of 5.50)
<br /> -----___ _ x .0005 $
<br /> (co;tact Di-;c,)
<br /> r„ e
<br /> 3. POSTAGE&HANDLING (Only on Mail-In Applications) S 1-
<br /> 1.50
<br /> 4. TOTAL PER1vIIT FEE (Add Lines 1-3 Above)
<br /> $
<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 r,Yemsmuat he added to the
<br /> estimated cost or contract price for perrfi3i ~fee
<br /> amount of the job cost, the City may request the usubmissi n of oses. In ea event that there th a z�cttual c nt the
<br /> fined-copy of the actual contract:
<br /> **The STATE SURCHARGE is .0005 of the Building Department at(952)249=46: 0 for the price.
<br /> i:.il: '''%416,S2 1 ',i 2 r��h.' 41 iii �,`"v ih `�Pal>:! tY.�+
<br /> The undersigned hereby applies to the City for issua ee of a Mechanical Permit agrees
<br /> to work in strict accordance with the or.'-• -:es of th- r ity and the regulations or the State
<br /> all
<br /> Minnesota, and certifies that all . atement: made • to of
<br /> correct. this application are complete, true and
<br /> 0/ i
<br /> Applicant's Signatur:4 /
<br /> -- -. ... �',Voil ✓�
<br /> Date: /�/ 2-
<br /> 3
<br />
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