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12/19/2011 16:26 7633838506 TOTAL COMFORT PAGE 03/03
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<br /> �] Yes,this section applies
<br /> The replacement of s Residen ial f�r�aPp>i�that meets all three ot'tl�e follawing rcquirement,g:
<br /> 1. Dacs not require modiFcation to eicctrical or gas service,
<br /> 2, Has a total cost of$500.00 or less;excludin the cost of the fixture or�ppliance: and
<br /> 3. Is improved, installed or replaced by the homeowner or licensed contractar.
<br /> Sk.ip next scction, if this applics; Cost of Pcrmit $ 155i00
<br /> State Sur�harge $ 5.00
<br /> Mail-In Fec(if Applicable} � 2•��
<br /> Total Permit Fee $
<br /> � �I ��iyy�, tl!1�9.Illlnu��IBIl; I ��II!NAiil;I _
<br /> !:�ICut;7ldlll•.'!I�iiL�'a�!i�J,rj��i�i�d���I�9i�� . I�, �'> > .
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<br /> Tf above does nat apply;follow guidelines below:
<br /> 1. ONT ACT PRIC * is 1.25%of contracl price with a(Minimum Fee of$50.0(1)
<br /> 2,500.00 ,� .o�zs$ �0.00 _
<br /> (eont7acT pricC) (minimnm SSp.QD)
<br /> 2. STATE SURCH RGE 2�gOO.00 x .p005 � �-4O ._
<br /> (contr�cr prioc)
<br /> 3. POSTAGE&HANDLING(,Only on Mail-In A,pplications} $_ �' —
<br /> 4. TOTAG PERMI.?FEE(Add Lines I-3 Above) �� �����
<br /> � * CONTRACT PR1CF., or J08 COST means thc a.ctual or estimated dollar amau.nt char�ed for the
<br /> permitted work including materials, labor, profit. and other fixed cosls. It is the amount to be charged
<br /> tn che customer for the work done. If any material, equ.ipment, labor or installations are furnished by
<br /> the owne�, tenant or any othcr party, che reason�ble market value oi'such items muse be added to the
<br /> estima.ted cost or contraet price for permit fee pu.rposes. ln the eve�nt th�t there is a dispute on the
<br /> amou.nt of the job cost, the City may request che suhmission of a signed �opy of the actual contract.
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<br /> lSilhG�����li�:!;I�ii�ijiiil).'llijE4"-�.�
<br /> The undersigned hereby applies to the City for issuancc of a Mechanical Perm.it, a�rees to do all
<br /> wark in strict accordanec with 1'he ordinances of tlle City a,nd the regulations of thc State of
<br /> Minnesot'a, and certifies that all statements made on this application arc complete, truc and
<br /> corrcct.
<br /> �
<br /> Applicant's Signatu. e:
<br /> Date: �2�16111
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