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05/12/2015 11:25 7634987618 COMFORT PAQTTERS HTGE PAGE 03/04 <br /> . , � <br /> �� �M�� ��f 7F 4y�r�+F+�� 11 �4�,����!��- T�+�������4� �"uF � �x� E � <br /> .���_��r���c� � C.��i �.-. (�-�� F y �`� �cr=f r �,�,�� ;���. <br /> r��., � f� > � �.;�'�:3-��'E'^J'�_� � Jr � �' n„ � <br /> � ,... r....� `Y_. � ��^9���m���r-`4"x_.. ..';f' .rr� �.�z� �..,w:.f . � <br /> .. ......_..... - . . -1 <br /> ❑ Yes,this section�pplies <br /> '�e�epl�ceme��t o;Fa Residcntial fixture or a lnn iance th�t meets all three of the�ollowing requicements: <br /> 1. Does�ot requue modi�cation to elecbr�cal or gas servzce. <br /> 2. Has a otaI cost o�$SOO,OQ or less;e c udin the cost of the�:�t��re or a��pliance:and <br /> 3. Is i�np�roved,installed or replaced by t}�e:homeo�vner oc licensed contractoz-, <br /> Skip next section;i�'tk�zs applies; Cost of Pezznit $ 15.00 <br /> St�te Surcl�arge $ 5.00 <br /> Mail-Ia�k'ee(If.�.pplicable) $_ 2.00 <br /> Total�ermit Fee $ <br /> If above does not appky;folaow gaidelizaes be:low: <br /> 1. .`TRACT CE *is 125%of contract price with a(Minimujm�'ee of�50.00) <br /> ']dIS �,o12s$ R�• l�l <br /> (contract price) (minimum$�0-00) <br /> z. sT�,�r�srrxcx.�RG� <br /> `��1� ��.0005 $� ��.�1 <br /> ��o�,u����;r���� <br /> 3. �OS�'AGE&H,�ND�;TNG(Or�iy oz�Mail,In Ap�lications) $ `2-�g� <br /> 4. TOTA�,:P�RNIIT FEE(,A,c�d Lines 1-3,A.bove} $ ��• 6� <br /> • * CONTRACT �'�CE or JOS COSx means the actual or estimated dollar amount charged for the <br /> pez�z�itted vrork izacludu�g materials,aabor,profit,a��d otlaer�xed eosts. �t as the�nount to be charged <br /> to the customer�or the work done. ��any material, ec�uipmen� Iabor or znstali�tions are fUrx►ished by <br /> the otvner,te��a��t or any other parry,the re�sor�able market value of such itenis must be added to the <br /> estimated cost or eontract przce for permit ;fee pua-�oses. In the event that there is a daspute on the <br /> amount of the.job eost; the City rnay rcquest the submission of a siga�ed eopy of t]ie actual eontract. <br /> The ut�dezsigned hereby a�pl�es to the City fot'issuance of a Mechatazcal k'ennit, agrees to do a(1 <br /> work in stt-aet aceordance with tk�e ordinances of the Czty and the regulations o£the State of <br /> IVliz�r�esota, and certifies tktat all statements zz�ade on tlus �pp��catxot� are complete, true and <br /> correct. <br /> ,A,pplica��t's Signatuxe: Date: � l �,� <br /> 3 <br />