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. <br /> E, <br /> ���;`=PERMI'�Ffifi��AL��ILATION(S� � � 'a ;.�F ° ':� � ����:� <br /> z; � ,� � <br /> -�� <br /> � - � �� — f� <br /> ,� ���, �a_��� <br /> � � � � �` :�° ��'�.� <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;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 Swcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee S <br /> d �. <br /> FRMIT F � � ,' ° •i � ��� � <br /> If above does not apply;follow guidelines below: <br /> 1. COIV�TRACT PRICE * is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> ��Q',0. 08 x.0125$���,Sd <br /> � (contract price) (minimum$50.00) <br /> 2. STAiTE SURCHARGE !��� � <br /> x.0005 $ g, �'i' <br /> (conUact price) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERM[T FEE(Add Lines 1-3 Above) $ ���,d� <br /> ■ * CONTRA�T 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 thC job cost, the City may request the submission of a signed copy of the actual contract. <br /> �'// y' : ., ,. <br /> iS k'. S �•�.:'"' �� � .���,� � f�l $" � �y 6 2 <br /> �t . 6 <br /> .�+M'l..�'' i�ya-`qgx,M' <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all <br /> work in strict a�ccordance 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 /> n <br /> Applicant's Signatu . Date: <br /> 3 <br />