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�''''�,';� 1�`2014/WED ���9, ?6 AI� Heating & cooling FAX �1�, P, OQ4;QQ4
<br /> ! � �l'"}�f91 h'�?i!1 �e Hy�'��r� �'+ti�t�'�'����.L� �� � � i Z�1� �i 1.i f y� ti s .
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<br /> + i� 4.�L.�'•�5.�. � ����T� l.t`���� � 1� �� .
<br /> [f 1'es,this section applies
<br /> The replacement of a Residential fixture or.appliance that meets pll three of the following requirements:
<br /> 1. Does not require modification to electrical or gas service.
<br /> 2. Has a tota] cast of$500.00 or less;excl a the cost of t:�e fi�.-ture or appliance:and
<br /> 3. Is improved,instailed or replaced by the homcowner ar licensed contraotar.
<br /> Skip ne�ct secYion,if tihis applies; Gost of Parmit � 15,O.Q
<br /> 5taee 5urcharge $ 5.00
<br /> Mail-In Fee (If Applicable) $ 2.00
<br /> Total Permit k'ee $
<br /> a�
<br /> � ^''. �' � � , "Ii. r � � r .,� ��f };,,.
<br /> �.;,r,.�.�L+�z?,�,�s�'�I;,ar �P�RIa/1`I�'�P� „��,.`''�y''G',I,7L2 �'���),�;`T��ix��v���Q:p;s;�Q�z�w�r,�,'�,'���.�i�."��,:r,�,�,`'���:'.
<br /> If above does not apply;follow guidelines below:
<br /> 1. CONTTtACr PTiYC� * is 1.25%of contraot price with a(Minimnm Fee oT$50.00)
<br /> _ �jo2� � x.0125$ �(� ��
<br /> (contract price) (m;h;mum 550.00)
<br /> �, S'Z'ATE SUItCHA�tGE
<br /> �d��' x .00as $ t�_ (� 0
<br /> (convact price)
<br /> 3. POSTAG$&HANDLING (Only on Mail-In Applications) $ 2_QO
<br /> 4, TO'�'AL PERMIT�'E�(Add Lizaes 1-3 Above) $ �� � �
<br /> ■ # CQN�REIC�' PRICE o� J0� COST means the actuaI �r estimated dollar amount charged for the
<br /> permiteed work including materials, labor,pro�t,and aYher�axed costs. It is tt�e amount to be charged
<br /> to the customer for the work done. If any m�terial, equipment, labor or installarions are furnished by
<br /> the own�r, tonant ar any other party, the reasoraable market value of such items must be added to the
<br /> estimated cost. or contract price for permit fee purposes. Tn thc cvent that there is a dispute on the
<br /> amaunt of the job cost, the Caty naay request t�ae suUmission of a signed copy of t11e actual cont�act.
<br /> � 1,S•��'i r��a!g7'o l�/�-Ca� �C..:f� s�'' -!.�q pS��'��*D!�� �q�� �k`�,7� :�xy{P' fi+�.y4�����''
<br /> � �4.�:'., .'FPTi 11.. ��- ,.' .," .:,.,'.'. .. ', �,.`..�P.. ���.:,. �4? ....�..... :��tl,.�(�A^`�.����Y. I a .YC�a ..,R...:"�4;. .�i�
<br /> The under5igned hereby applies to the City�'or iSsuan�e of a Mechanical Permit, agrees to do al]
<br /> work in sttict accordaz�.ce with the ordinances o�t1�e City and the regulations of the SCaCe of
<br /> Minnesota, and certifies that all statements made on this application are complete, true and
<br /> carrect.
<br /> Applicant's 5ignature: ' � e�_ Date; �-r�.(� ��
<br /> 3
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