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From:COUNTRYSIDE HEATING & COOLING 763 479 2518 10/25/2013 09:16 #837 P.0031003 <br /> ..:y„, . . 3, ' <br /> ���!�,����� <br /> ��'-',�" = <br /> .�,x��`�,�:"' '� <br /> ❑ Yes,this scction applies <br /> The repiscement of a Residentiat 6xture 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]ess;excludine 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 $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicabie) $ 2.00 <br /> Total Permit�ee $ <br /> ����� �: � .,ti.p _ <br /> �,.�� <br /> 1f above does not apply;follow guidelines below: <br /> I. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> � Qa0-4X� x .0]25$ �7- ��/ <br /> (conuact price) (miAimnm 550.00) <br /> 2. S'I'ATE SURCHARGE 2 <br /> x.0005 $ o,�, � <br /> (contract price) � <br /> 3. POSTAGE&HANDLING(Oniy on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE{Add Lines]-3 Above) $ q�� � <br /> ■ * CONTItACT PRICE or JOB COST means the actual or estimated dollar amount chazged for the <br /> permitted work including materials,labor,profit,and other fixed costs. It is the araount 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 mazket value of such items must be added to the <br /> estimated cosi or contract price for permit fee putposes. 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 /> �;n���� �.�- _ <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 stateraents made on this application are complete, true and <br /> correct. <br /> Applicant's Signature: Date: °''��� �(� <br /> 3 <br />