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FEB/19/2014/WED 07:52 AM Heating & cooling FAX No, P, 004 <br /> r . <br /> Y \Y <br /> .. r <br /> , <br /> The lacernent of a Residentisl'fixture'or a liance'tl�af'meeis all three ofr{he fol]o r' melt <br /> . . . g <br /> is <br /> .. ,..... <br /> , <br /> C <br /> ti Il t0 5 <br /> 1. o z. �avcliii a v clecw 1 Ot as,service. <br /> Has total:cost` Sdd:00 or less='exclu' <br /> di' E'cosC o 6r APP e.: <br /> 2:' a of'$ � �$`cli, f.ti�� x. Mian .:ei1;d� <br /> 3' <br /> ove' installe 'r re l 'e ahe ho bd" et'of <br /> r ' <br /> 0 ac d.b.. ti1 v✓a livens ''cnritractor,` <br /> ... !' <br /> ort a '0 if this a lien Costo <br /> r . <br /> ,,Slap - n, 1?P � .. ...:: <br /> ..state.: <br /> S c - 0'. <br /> ,i <br /> .Sur <br /> .Mail- <br /> ..... .. .. .... .. ..:. qql .0 <br /> T4't' e" 't ee' <br /> 4 <br /> 1. <br /> I <br /> i' <br /> r.y. <br /> do -1.Y'�.ollA'' <br /> "define•'s`�iet"o''w:,:�,' <br /> gui <br /> ONC�'RAC'T-PSC *.is 1 5%' �co" �i° "ce .;ini u <br /> � � � Qf ntrac, 'n„ w�tl�a.: m m`�ee.�of' <br /> .l I f... .w.. +. ...:.' <br /> n <br /> 1 <br /> 1I.S•I <br /> ti <br /> . .. .r, <br /> SURCHARGE :.. 'Add.tbe Stat a •V'a i'* <br /> e, ldg i'�o Di cka'ge `iuii�ulxi F 5oj�" <br /> r (Golld'aCt,pT��A) '.1tt111F11hI117t,b'�•�).,� �/, ,,41 <br /> 3 POSTAGfi&'HANDLING(bey onMal-J�i;�+T�plieatioixs)' <br /> f 4• � � 4„LI`' <br /> 4 TOTAY,pRRltIIT)~lJ] Add Tinea 13 Above) x <br /> ..: ... ..�. .' .,.ter:. <br /> # CONTRACI-PR10E::or JOB1'COS...mean*.` tire <br /> ,. ... � 4� }e :�ollaaioioi'at,chai`ged <br /> ernut614'' -`4 k'incln3xn matein'als labor ofi` anil atlict.fi�icd posts::'It:is the ainounf'to`6e;c' ed, <br /> P' .. <br /> to '04 £or:the work'done. .If ari feria mlabor orcin f tip' `are lied';b <br /> Y <br /> the owner,tenaii 'or an other a the:reasoiia le maiket' Y <br /> y p.rty, - :slue9f.s�cl. ltePs must"be:added'ao t ie <br /> • <br /> estutaateci cost or coiat5 ct puce.for permit.fee'. ones. Tn i]ei -verif'that thele;is a ilu"'.bo the <br /> BAiount'of'the ob oast;.tha City.'n3ay:#e est,; inissibn of'.a si ed pf the actual'Ponta. , <br /> .-SPY <br /> The STAT)3.SURCI ARGE is:0005 of the Building b" pait�ent at:952 24 <br /> ■ *'� .. ep (� ,) 9-4.600£or the puce. <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 stat emen 'de on the ppl` tion arc CQmplet.G, frac and . <br /> Im min <br /> correct. <br /> Applicant's Signature: / Date: ( � <br /> 3 <br />