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From:7634974263 02/11 /2015 12:03 #533 P.004/004 <br /> N-1,:77','"'W---'''.";7-7-,-9,x "4,w y �u ,;- tau a`-',:h.';',-- ta_ <br /> sF ��� ,�r 'qt �`ccam, t se� r�y � �`���1Cyt i3 �d" � � a '� <br /> ta,.cN.,�.,_.��...ax;,:�'2,�'„tti,�� �� _. �3 .�.�. , , ,$_ 1Ls1...�a.. ,azss r.,'�m __,Z... j_f <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requirements: <br /> 1. 0 i.-. *t require modification to electrical or gas service. <br /> 2. H.s 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 nct apply;follow guidelines below: <br /> 1. C$NTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> l B acc, x.0125$ <br /> (contract price) (minimum$50.00) <br /> 2. STATE SURCHARGE <br /> x.0005 $ <br /> (contract price) <br /> 3. POSTAGE&HANDLING(Only on Mail-1n Applications) $ 2,90 <br /> 4. TO74L PERMIT FEE(Add Lines 1-3 Above) $ <br /> ■ * CONTRAPRICE or JOB COST means the actual or estimated dollar amount charged for the <br /> permitted w rk including materials,labor,profit,and other fixed costs. It is the amount to be charged <br /> to the custo er 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 /> estimatedt or contract price for permit fee purposes. In the event that there is a dispute on the <br /> amount of cot <br /> a job cost,the City may request the submission of a signed copy of the actual contract. <br /> t 4 t. ,1 ( , l iia sly"V43., <r36 N ` . NrL �k 2z"• <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: ` -; ^ . .�, , Date: ire-J)-)_e i <br /> µ' <br /> x <br /> 3 <br /> 4 <br />