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WIABITTPTIMW: i w E5 BlAW h.Y v g E f ;EjT " d i � �' : i. , a F.ti' .4 <br /> BM � Y A W" <br /> ❑ RZM <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 /> WP'26? r a <br /> .. : ti , I£ .4-..k��g y t�Yi 4a i; <br /> .f .. <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE * is 1.25%%contract price with a(Minimum Fee of$50.00) <br /> iV5 3cP0 x.0125 $ <br /> (contract price) (minimum$50.00) <br /> 2. STATE SURCHARGE <br /> 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) $ <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 /> q tr, i ,-kt iir X n �,E P.7R [fk�@'k a��2�8� <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 /> 0 <br /> > <br /> A licant s Si nature: e Date: / <br /> C7 <br /> Pp g .7 - <br /> 3 <br />