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From:COUNTRYSIDE HEATING & COOLING 763 479 2518 05/14l2014 11 :37 #958 P.002/005 <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or ag�liance that meets al]three of the following requirements: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excludin�the cost of the fixture or appliance: and <br /> 3. ]s 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 $ SAO <br /> Mail-In Fee(If Applicable) $ 2,OQ <br /> Total Permit Fee $ <br /> If above does not apply;follow guidelu�es below: <br /> 1. CONTRAC'I'PRICE * is 1.25°/a of contract price with a(Minimum Fee of�50.00) <br /> � �-� x.0125$ l Q,Q , o 0 <br /> (contract price) (minimum SS0.00) <br /> 2. STATESURCHARG.E <br /> x.0005 $_ �• �� <br /> (conrract price) <br /> 3. POSTAGE&HANDLING(Only on Mail-ln Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) � l�`�• '�'� <br /> ■ * CONTRAC7' PRIC� or JOB COST means the actual or estimated doliar amount charged for the <br /> pertnitted work including materials,Iabor,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. <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 /> conect. <br /> Appl icant's Signatw•e: � __ Date: ����'�L' <br /> 3 <br />