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From:COUNTRYSIDE HEATING & COOLING 763 479 2518 10/25/2013 10:28 #838 P.003/003 <br /> ��� a <br /> . . <br /> s,,�� � . .. _ . <br /> ❑ Yes,this section applies <br /> The replacement of a Residentia)fixture or appliance that meets all three of the following requirements: <br /> 1. Does not require modification to etectrical or gas service. <br /> 2. Has a total cost of$500.00 or tess;exclu 'n 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 /> Mai!-In Fee(If Appiicable) $ 2.oa <br /> Total Permit Fee S <br /> �, <br /> ��`R�`°� y.. - - - <br /> lf above does not appty;follow guidelines below: <br /> l. CONTRACT PRICE *is I.25%of contract price with a(Minimum Fee of 550.00) <br /> S3 �(� ao <br /> —__ X.oi2s$ �O6.,S� <br /> (contract price) (miaimnm$50.00) <br /> 2. STATE SiJRCRAItGE / C <br /> x .0005 $ -�O v <br /> (conuact p�ice) �� <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ ��. Ol.� <br /> � * CONTRACT PRICE or JOB COST means the actual or estimated doliaz amount charged for the <br /> pernutted 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 instatlations are furnished by <br /> the owner, tenant or any other party,the reasonabie market value of such items must be added to the <br /> estimated cost or contract price for pernnit fee purposes. In the event that thete 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 /> s-:.� �.: - •�• - <br /> �-. � <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 Ciry 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 /> ApplicanYs Signature: G%�� `'' Date: `Or��(J <br /> 3 <br />