4 1.'x.6/2014 09:10 9524927729 ZAHLER HEATING & A/C PAGE 07
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<br /> �i n w'���� I�iJ�,•o�f"A 'ti$ ��'a i� + Gi ny � Sh ib� '� I i x � � ,1 'uT^�
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<br /> 0 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 t of$500.00 or less;excluding 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 /> Mail-in Fee(If Applicable) $ 2.00
<br /> Total Permit Fee $
<br /> al M" w n *,rr,^n t Ny' .*fix', ii ',Eli Y
<br /> If above does not apply;follow guidelines below'
<br /> I. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$+0000))
<br /> .0
<br /> 244.1760 x.0125$ i11 • ;g
<br /> (contract price) (minimum 550.00)
<br /> 2. STATEAJRCHARGE
<br /> ''Pt, 7,51) x.0005 $ _ �� •!
<br /> (contract price)
<br /> 3. POSTAGE& FIANDLING(Only on Mail-1n Applications) $ 2.00,
<br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ 3 L . 5(0
<br /> ■ * CONTRACT 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 the job cost, the City may request the submission of a signed copy of the actual contract.
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<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 statements made on this application are complete, true and
<br /> correct.
<br /> Applicant's Signature: �_ Date: f 741 If 11 +
<br /> 3
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