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04/15/2015 16:a4 FAX 9524422451 sgs �004 <br /> FERMI'f FEE C�..G'G�'LA'iZC��T(�) <br /> BA���0�1����2 STA1'fi ST ' <br /> Q Yes,this section applies <br /> '�he replacement af a Ros'dential fixture or apyliance that mcets all threa ofthe following requirements: <br /> I. �n�rcquire madification to cicctrical or gas scrvice. <br /> 2. 1•las a al co of$560.Q0 or less;�ill�the cost of the fixture or appliance:and <br /> 3. ls improved,installed or replaced by the homeowner or licensed contractor. <br /> Skip next section,if this applies; Cost of Permit $ �;5,00 <br /> Stato Surchsrge � 5�44 <br /> Mail-ln I�'ee(lf Applicable) $ 2.U0 <br /> Tofa��'ermit Fee S __ <br /> ��Mh�,�*'T�Y.���V�L1��� � W,�Y�W�Q.I�� ������ <br /> If above does i�ot apply;follow buidelincs bClow: <br /> 1. CON'i'C2ACT_ R� * �s 1.25%of contract pricc with a(Minimum Fee of S,S0.00} <br /> b t x,0125$���. ��i? _ <br /> (cuntract pricc) (minimum 5�1�U0) <br /> 2, 5TATESURCHARGE � <br /> __. x.0005 $��- CP� <br /> (conlrucl pYice) ��� <br /> 3. Y�STAGE&HANF�LING(Only on Mail-In Applications) $ ?•�� � � <br /> 4. TOTAL P�RMIT FEE(Add I.ines 1-3 Above) S " � ��• i�t� ._ <br /> • "' CONTRACT PRICE or JOB CU5'I' means ihe actual or estimated dollar amount charged for the <br /> permilted wark ineluding materials,labor,profit,and other flxed costs. lt is thc�mount to Uc charged <br /> to the customer for the work done. lf a�ay material,equi�ment, labor ur installations are furnished by <br /> tha owner,tenant or any other party,the raasonable markct value of such items must be addcd to the <br /> estimated cost or contract price for permit fee purposcs, In the event that there is a disputc on the <br /> amount o�'the jab cost, the City may roquest the submission of a signed copy of the actual contract. <br /> " ��'i�AL F�1�1�TIT A�'PLICA`IIC]�I AY�3F.E�MEI�T `; <br /> The undersigned hereby applies to the Cit� for issuance of a Meahanical Pennit, agrees to do all <br /> worlc in strict aeeordanee with the ordinances of the City and the regulations uf the State of <br /> Minnesota, and certifies that all statcments made on this application are complete, true and <br /> correct. - -- <br /> Applicant'S Signatu• . _ Date: �/U`-�'� __ <br /> 3 <br />