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01-10-'17 12:24 FROM- T-676 P0003/0004 F-823 <br /> ii <br /> ..t.,+..•Yl..���Li.h,,.�,d.,S 4�.,.r."?S {�1 '?17.etcY.V s?.�IJ,.4, .N��.'Ai, .}f!k,4f 14„!$.5':F.�{ in a�NYN' �.bIEQit <br /> D 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 /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE * is 1.25%of contract price with a(Minimum Fee of��S50.00) <br /> ( /' <br /> x.0125$ "7. ca9 <br /> (contract price) (minimum$50.00) <br /> 2. STATE SURCHARGE <br /> 561-751 x.0005 $ 2_ 619 <br /> (contract pricc) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ t L <br /> 71 <br /> — ,la <br /> 4. TOTA>`.1PERiv>i1T 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 /> n l ki:.araNIOA'1!:Pr1�.l a 1"jATJ,O}lIX0d.L?F!d1J/P.Ar�Li En�1i�:1 i..r ii :a:'k <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 /> /7 <br /> Applicant's Signature; API Date: /_--/0.-- <br /> t7 <br /> J <br /> 3 <br />