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. <br /> : . <br /> ` <br /> ����' �°�`�k��a =`#{��,�'}�r�'"„+�v a` � �� k ' � � �'�`'`��A�C`�''�y"5,��"�"����"�.s c� t �n������� <br /> � �,� �� � ��'�� � ' � � �5' ,� �� �s r^ �`'� �;'� s��cz � � ��`ti4�`�"'t <br /> �`7 ��:`�-'���� `��� � ��..� � '� ,��� . !�a"��� �-t�'��'�F`������;�,� h'' <br /> '�� a � � '�r. �� �" ; y . t� �i��� .w.�'S� <br /> . .N�.'S.o�a�'70.'a� 7..�:�. n. .�..,. . ,. .... . _ . , .. �e„ , . -� � ° � • ..,, .����. <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the foilowing requirements: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excludin�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 /> ,v � �_� <br /> �c:, . t�*." .� � sv f �a 2k �� ���.���� ��� �'+e'�.Sx�'�'�':.: <br /> ,4"�a ���'S�r �r�{�'ik'��n,�p:� ���. � �� b �� <br /> If above does not apply; follow guidelines below: <br /> 1. CONTRACT PRICE * is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> ��00•0� x.0125$ <br /> (contract price) (minimum$50.00) <br /> 2. STATE SURCHARGE <br /> x.0005 $ <br /> (contract price) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ <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. 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 /> � , ,a�; �� � � � �����: <br /> (rtK �s;, � x��i,!, t`r, �.. �;���, �. �m �.kx�_x ���,.��''�'�ri e�,§'.��. <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 Signature: Date: � � � <br /> 3 <br />