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. <br /> From:COUNTRYSIDE HEATING & COOLING 763 479 2518 12/16/2013 14:46 #880 P.003/003 <br /> " $ F 6 r ,anis+ `�70,I ' p r"F t F d' ..f a^a,� <br /> � Y -P E E v.. �� Y�� � � <br /> 0 Yes,this section applies <br /> The replacemert of a Residential fixture or appliance that meets all three ofthe following requirements: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;exchidina the cost ofthe fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor. <br /> Skip neet section,if this applies; Cost ofPermit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-InFee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> -rzgaie :4 <br /> If above does not apply,follow guidelines below: <br /> 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> c x.0125$ r7/? •7 <br /> (contract price) (mini um$50.00) <br /> 2. STATE SURCHARGE f x.0005 $ .17 /0 <br /> (c cnmract pr=e) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4, TOTAL PERMIT FEE(Add Lines 1-3 Above) $ /57. ,3 ) <br /> El * 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 mist be added to the <br /> estimated cost or contract price for permit fee purposes. In the evert 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 /> .•�'�` W� �� "`Z ��rv��r r�` ����` .': C`Tom`f"�,l� €J; � � ��-r- -� �..�.P.`r+. <br /> The undersigned hereby applies to the City for issuance of a Mechanical Penni, 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: /;?-/4 /3 <br /> 3 <br />