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ri i4 �4.z.y-;s#e411 df f!f .5.�,.;4,5 <br /> d� ,t. N +�0x • <br /> : `} 0i t$IX As1!',I"^aFia3nt k :+}� 4re `y4 1Yt 7�) t <br /> � r 1 ;; r ui, ,i .,$("* � r, ,N ,k.�ai�ED'Ot !t /02. .��S,TATtIt M '1!ii '? b fJ'3A ' . Ne ''n?, : <br /> *•:c <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;exc udint;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 $ .50 <br /> Mail-In Fee(If Applicable) $ 1.50 <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$35.00) <br /> �j.i'd)Ox.0125$ gof.aJ <br /> (contract price) (minimum$35.00) <br /> 1 <br /> 2. STATE SURCHARGE **Add the State Bldg Code Div.Surcharge(Minimumm Fee of$.50) <br /> ID. D .-- x.0005 $ >• a9 <br /> (contract price) (minimum$ .50) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ 0'Z <br /> Cei <br /> a * 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 /> ■ **The STATE SURCHARGE is.0005 of the Building Department at(952)249-4600 for the price. <br /> '1 EC TICA:L,PEIMI r APPI'ICATTC NACRE NieN ')1.;17 , ` <br /> i <br /> i <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. 441. <br /> Applicant's Signature: L,yA ter, -.. ® Date: �r-7201' <br /> 3 <br />