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01/18/2012 13:29 FAX 7634283682 HEATING AND COOLING TWO 1@004 <br /> " 414. <br /> IM <br /> ❑ Yes,this section applies <br /> The.mplacement of a Residgttja4.f.1X-tWe or appliance that meets all three o£the following requirements <br /> I. Does not require modification to electFical or gas service. <br /> 2. Has a total cost of$500.00 or less.,excluding the cost of the.fikturc or appliance:and <br /> 3. Is improvedi ii:Ystalled or Ycglaced.by-66 Izo.meowner or'licensFd contractor. <br /> Skip next section,if this Applies- <br /> Cost.of Permit <br /> State.S'urcliarge <br /> 1ldail=I Eoe('If App} able) $ <br /> �iutod-Firad—Vee, $ <br /> ifi does-kot apply;&16vv gtiiilelinirs�below; <br /> l: <br /> o . <br /> CONTRAG'P�PI�YCE is 1:25/a'ofcontractpfice wifh a;(Mtluaium�I+•ee of S35'.00). . <br /> X,0125$ <br /> ( ntractpdce) (minimum 935.00) <br /> 2. STATE S URCPiJk2GE **Add the State Bid;Code Div. Surcharge(Minimum Fcc of$•io) <br /> x.0005 $ _ <br /> (contract price) (minimum S '.50) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 1.5�__ <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ _ <br /> k * CONTRACT PRICE or JOB COST-means the actual or estimated dollar. Ono= charged foe the. <br /> P.emitted work including rnatenals,'labor,profit,.and other fixed costs.. It is the amount to.be cku.;ged • �. . <br /> to the customer for the w' dr dome. If any rnizenal, equipment, labo=.,br installations are futaishe d by <br /> the.owner, tenant or',any other:party,•the•i'easonable market value o€such iteins-must be added t)-the <br /> estimated cost or conteact 'Floe.poi <br /> p peiiitee;pait ;oses•: In the-evinf that t6ee is a displuto oa the <br /> amount ofihe job cost, the City:may iequest the.submission of a•sl ned copy Af the actriil som act' <br /> • **Tbe'STATE SUR(HARGE is.0005.of.-the$uildinng17epaitment,•$�:(952)24Q'600 fo'r the•prnic;. <br /> The undersigned hereby applies ta the City for issuance of a 1Vleclianicall?errnit,.agrees to do all <br /> work in strict accordance vizth the ordinances of the City and the regulations of. the State of <br /> Minnesota, and certifies that all staterrne nlade 0 i.s application afire complete,. true and <br /> cotrect. <br /> Applicant's Signature:.� .`pate: <br />