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04-11-'16 14:19 FROM- F I RESIDE T-845 PO003/0004 F-281 <br /> - ice ems# _�T•f� 4d 'fF�� �-47:t��.7„,,„, <br /> op <br /> —\717,-'0.' { u <br /> 0 Yes,this section applies i <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) $ 200 <br /> Total Permit Fee $ <br /> co..y,_. � , •:-1"B= 4 - 1..smif,;:a.l_0Jrr', .i '�AL� o!Ali!'lti"�j.' ,0 t=!i y '—N <br /> .?^.1'T��>ic+`+�ir' ,. .. Z,:`._ 76�t1r '.�� .� �.— z xs,::� <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 /> codtg iso» ;.._. ( ft!l ;iim t <br /> 2. STATE SURCHARGE <br /> .3'7n1---(' x`-06,:ems _ I lakiiittoggioy <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) 443 *2•:OOi.,;...e. ,-,7::9 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) -LS•a' : :w':: =:•; <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. It'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 /> :•.',..,'--""---...7. :AF.6-I bMIlCt i_`-aq04,41-Mi 6:1:1:.' ' ;71.:: .1:7, ,-4- <br /> .5 .y it,-E.---4 <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 Signatun ,.. E aa:e4::� 1///A Y'r <br /> 3 <br />