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11/06/2012 16:24 6128278292 W.F. RIDLER HEATING 6 COOLING #4161 P.003 /003
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<br /> . ❑ Ycs,this section applies
<br /> The replaccmcnt of a Resideniial f�,ture ar applianc�th&t meets all zhree of thc following requir'ements:
<br /> 1. Does not require modificalion to electcical or sas servicc.
<br /> 2. I las a Lotal c�st of$500_00 or lcss;�xcludin�the cost of th�fix�ure or app{iance:and
<br /> 3. ts impmved,installed or rcplaced by �be homeowner or licenszd contractor.
<br /> Skip next section,if this applits; Cost of Permit $ I S_00
<br /> State Surcharge $ 5_00
<br /> Mail-ln Fee(If ApplicablG) $ 2.00
<br /> I Total Pcrmit Fee S
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<br /> Lf above does not apply;follow guidelincs bclow:
<br /> '�, 1. CONTRAGT PRICE *is 1.25%of conLraet price with a(Minimum Fee of$50.00)
<br /> � �f� G G 4 x.O I25$ 5�- 3 Z
<br /> (contraCt p�ice) (minimum S54.00)
<br /> � ; 2. STATE SURCHARGE y/� � G Z 3 Y
<br /> x.0005 $
<br /> i (conuact pricc)
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<br /> ' 3_ POSTAGE&HANDLING(Only on Mail-ln Applications) $ 2_00
<br /> 4. TOTAL PERMIT��E(Add Lines 1-3 Above) $ ��� � �'
<br /> • ; C:ONTRACT PRICE or JOB COST mc2ns the actual or estimated dollar amount charged for the
<br /> permitted work including materials,labor, profit, and other fixed costs. !t is the amount to be chatged
<br /> to the customer for the work done. 1f any matcrial, cquipment, labor or installations are furnished by
<br /> thc owner,tenant or any othcr party,the rcasonablc markct value of such items must be added to the
<br /> estimazed cost or contract price for permit fee purposes. In the event that therc is a dispute on the
<br /> amount of the}ob cost, the City may request the submission of a signcd oopy of the sCtuBl cont�act.
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<br /> The undersigned hereby applies to the Ciry for issuance of a Mechanical Permi�, a�rees to do all
<br /> work in suict accordancc with thc ordinanccs of thc City and the regulations of the Stace of
<br /> Minnesota, and certifies that all statements made on this application are complete, vue and
<br /> correct.
<br /> I Applicant's Signature: ------- ...._.._____.....,. ... Date: I/ G z. ��z-
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