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O1/13/2016 wED 11: 27 FAx 763 �73 8565 S�bre xe�ting b Ai.r Cond f�444/OOa <br /> I <br /> jy , . • <br /> � <br /> � Yes,this aection appliea <br /> T'he replacement of&Residential fixiure or a�pliance that meots e�ll thrce of the follawing requiremeniS; <br /> 1. boes not requiro modi�Ccation to Blectrical ox gxs service, <br /> 2. H,as� 1 of$500,00 or lesg; cl in tha cost of the fixture or appliance�and <br /> 3, Is improved,inatelled or replaoed by the homeowner or licensed contractor, <br /> _..--:.:--,._._..,,...... . ,._........_. ... : . �--�— —�--._.... , <br /> Skip next section,�f thia appl'ies;� � Cost of Permit � $� . 1 S•00 <br /> State Surcharge S__.. S.�Q <br /> Mail-Tn Fee(If Applicsble) $ 2.00 <br /> Total Permit Fce S <br /> If above does not apply;follow guidalines below: <br /> 1. CaNTRACT�RICE •is 125°10 of convaot prir,s with a(Minimum Fee ot�50.00) <br /> i ,��, 3f� .�_ X.o�zss ���.•3l <br /> c����a) c�►�ssao� <br /> 2, ��'A��c�c� ���$� a�X.000s s 2l�1 <br /> � c���p�> <br /> � <br /> , 3, i�STAGE&HANDLING(Only on Mail-Tn Applications) S Z.00 <br /> �j 4. TOTAL PERIVIIT FEE(Add T,ines 1-3 A6ove) S '�J(d .�� <br /> ' ■ " CONTRACT PRICE or JOH C�S'�mea�ns tha sctual or esdmated dollar amount charged for tha <br /> •; permitted work incfuding matariale,]abor,profit,and othar fixed costs. Tt is the smount to be charged <br /> i tQ the customer for the work done, If a,�y material,cquipmant, labor�r i►�tallations are furniahad by <br /> ' the owner,tenant or any oth�party,the r�sonablo market value of sucl�itams must be added to the <br /> astimatsd cost or contract prica tfor permit fen purpa�es. Yn the eveirt that there is a disput�e on the <br /> amount of the job cost,tho City may requast ihe subm�ssion of a signed cflpy of tho aotual contract <br /> , The undersigned hereby applies to tho City for issuance of a Mechanical Permi�agrees to do all <br /> work in striot accordance with the ordinences of tha City and the regulations of the State of <br /> Minnesota, and certifies that all stat�ne�ts r»,ada on #his applicaxion are comploto. tru.o and <br /> , c�rr�t. . <br /> Applicant�s s����: ����_�A�� ___ �ate: I-I�•ZaL <br /> I � � , <br /> _� 3 <br /> I <br /> ' . . . . <br />