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L , �, <br /> 1°ER1Ft�I'I' �'+E'� �A�.,C�.TI.�'�'�C?l�(S) <br /> 2002 State StatuCe ❑ �.'�� �'his �;eeiion�,ppPies <br /> Tl�e replacement af a Residential fixture ar ax� liance tllat meets a11 three of the following requirements: <br /> 1) Does not require modification to electrical or gas serviee. <br /> 2) Has a total cost of$500.00 or less; excludin�the cost of the fixture or appliance: <br /> and <br /> �) Is improved, installed or replaced by the homeowner or licensed contractor. <br /> Skip next section; Cost of Pennit $ 15.00 <br /> Stat:e Surcharge$ .50 <br /> IV`iail-In Fee $ l.50 <br /> I'f above does not apply, follow�uide].ii7es below: <br /> �. ��n�a-�et ��•e�e* is .012�°io of job with� T����in�um I�ee of(�?5.00) <br /> L��CC,��� x .0125 $ �C'�C��� <br /> (contract price) (minimum$35.00) <br /> 2. �tate Surcharae, �°* Add the State Buildind Code Division a ii'Iinimum Fee of($ .5� <br /> ��/�',�^_. x .0005 $ � �-� <br /> (contract price) (minimum$ .SOj <br /> 3. �'�s8age and�andiing (�saly r�zraif-in ap�vZicatio»s) $ �- <br /> 4. '�'�i AL ��T���' ��� (Add Iines 1-3 above) $ _�.�� � <br /> *COt�ITRACT PRICE or JOB CO5T means the actual or e;timated dollar amount charged for the permi±ted work including <br /> materials,labor,profit,and other fixed costs. It is the amount to be charged to the cusfomer for thc work done.If any materiai, <br /> equipment, fabor,or instal(ation is furnished by the owncr,tenant or any other party thc reasonable marl<et value of such items <br /> must be added to fne estimated cost or contract price for permit fee purposes. In the event that there is a dispute on the amount of <br /> thejob cost,the City may request the submission oi a signed copy of the acTual contract. <br /> **The STATE SURCI-IARGE is.0005 of the contract price under�I,000,000 or$.50-whichever is greater. For valuations over <br /> $1,000,000 call the Department of Inspectional Services for the price. <br /> The undersigned hereby aop?ies to the City for issuance of a Mechanical Perniit,agrees to do all worl<in strict accordance with <br /> the ordinances of the City and the regulations of the Minnesota State Building Code,and certifies that all statements made on chis <br /> application are complete,true and correct� <br /> i / <br /> Applicant's Signature: � ' Date: <br /> Approved By; Date; <br /> � 3 I <br />