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11-16—'15 15:32 FROM— T-438 P0006/0007 F-778
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<br /> 0 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.
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<br /> Skip next section,if this applies; Cost of Permit $ 15.00
<br /> State Surcharge $ . 5.00
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<br /> Mail-in Fee(If Applicable) $ 2.00
<br /> Total Permit Fee $
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<br /> „ .,,..L.:... ,.:9', .....��� 1:;.�E�i:.(�.A;L�.T;XLATIQN{Sl.,.�>7®,�5�4;�!".��•.$S.QOt)��'-`�.,:w�.�.�;�:.,,�':�;�:::�<;�.
<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 /> (contracf'pricp)' t,(ulninium,3,SQ OOy
<br /> 2. STATE SURCHARGE /2)U90.
<br /> URCHARGE (UCn9(� -
<br /> t V 3c:00.65',;
<br /> (ont ler price)'
<br /> 3. POSTAGE&HANDLING(Only on Mail-in Applications)
<br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) . ' •
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<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 /> . °� t %:�,,. .�'� �`I��A'�%;PEST':•;AEE :ICAT��1�.,�1.C•...G � 1��'�-���� . .° .. .� .�.:,
<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 /> Applicant's Signature: ,Date:-.` (tQ
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