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<br /> ❑ 'Y"es,thts section applics . .. • .
<br /> The replacement of a Residential fixture or appliance tk�at K»eets all tbxee of the following rccXuirements:
<br /> 1. Does not require ncwdi�lcat�a�7,ro eaect�'ic�l or gas ServiCe. ,
<br /> 2_ '�as a tota�ost of$500.00 or less;excludine the cost of the fixture or appliarice:and
<br /> 3. is improved,installed ar replaced by the homeowner oz Iieensed contracbor.
<br /> Skip next section,if thas appaies; Cost of Permit $ 15.00 '
<br /> State Surcharge $ 5.00
<br /> Mail-In�ee(Xf Applicable) $ 2_00
<br /> �'Otal�e�At�ee S
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<br /> If ab0�e d0es not appty;follow guidelines befow:
<br /> 1. CONTRACT PRICE *is 1.25"/0 0�con4ract price with a{Minimum Fce o�'�50.00)
<br /> X.oxzs� r S��
<br /> (contracc pitice) (minnoum S50.00)
<br /> 2. STATE S�CHARGT � L�
<br /> x.0005 $ � `�
<br /> (contrut pri�e)
<br /> 3_ PpSx,A,G�&HANDLING(Only on Mail-In Ap�licaCions) $ —�66--- ,
<br /> 4. TOTA�kERMXT�'EE(Add Lines 1-�Above) S e V
<br /> ■ * CONTRACT PRIC�or JO� CdST means the actual or estiir�ated dollar amouttt charged for the
<br /> pe►rnitted work it�,cluding materials,labor,pro�t,a�td oth�er�i�ced costs. It is the amount to be chsrged .
<br /> to the customer for tbie woz�c done. If any material;equipment,labor o;r'tustallations aze furnished by
<br /> tt�e own,e,r,tenane or any other party,rhe reasoz►able market vatuc of svch icems musc be added to thc
<br /> estimated cost or co�►tract p�eo for peamit fee purposes. Ir�t17�e event that there is a dispute o�, tb�e
<br /> amount of the job cost, the Ciry may request the submission of a si�►ed eopy of thc actual contract
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<br /> The undersigned hereby applies to the City for issuance o�a Mec�anical Permit,agrees tu do all
<br /> work in stric� aceazdau�ce with the ordinances of tbe City and the regulations of tbie State of
<br /> Minnesota, an�d certifies that aIl stat ts znade on this applieation� are complete, tnie and
<br /> cocrect.
<br /> Applica�at's 5ignaiure: Date: (� a ��
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