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11/67/2012 12:17 9529222434 SAYLER HVAC PAGE e4/e4
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<br /> � Yes,this section applies
<br /> The replacement of a Residenrial fixttue or appliance that meets ala three of the following requirements:
<br /> 1. Does not require modification to electr�cal or gas service.
<br /> 2. Has a total cost of$500.00 or Icss;excludin the cost of the�ixture or appliance: and
<br /> . 3. Is impraved,installed or replaced by the homeowzlet or licensed contractor.
<br /> 5kip next section,if this applies; Cost o�Permit $ 15.00
<br /> State Surcharge $ 5.00
<br /> , Mai�-In�Fee(If Applicable) $ 2•Oq
<br /> `�'otsl�ermit k'ee �
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<br /> If above does not apply;follow guidelines below:
<br /> l. �ONTRACT PRICE *is 1.25%o�Econta'act p�ice with a(Manimum Fee of$50.00)
<br /> �.00�,00 x-0�25� SO.oO
<br /> (contract p�ce) (minimum$50.00)
<br /> 2. STATE SURCHARGE "s Add khe State Sldg Code Div. Surcharge(Minimum Fee ofS5.00)
<br /> l pUd,D O x.0005 $ S•DO
<br /> (convact price) (minimum S 3.00)
<br /> 3_ POSTAG�&iTA.M�I.17VG(Only on Mail-Io Applications) $ 2.00
<br /> 4. TOTAL PERMIT FEE(Add Lines l-3 Above) $
<br /> ■ '� CONTI7ACT P1210E or JOB COST mcans the actual o� escitr�ated dollar amount charged for the
<br /> �eamitted work including nn,aterials,labor,pz�o��,and otb�er faxed costs. It is thc amount to be charged
<br /> to the custo�mer�ior the work done_ If any matcriai, equipmcnt,labor or installations ere furnished by
<br /> I che owner, tenatat or any other party,r,�e re�or�able�ar�Cet value of such ite.ms must be added to the
<br /> estimated cost or con�act price for permit fee purposcs. ln the event that there is a djspute ott khie
<br /> amount of the job cost,the Ciry may request che Submisslon of a sigrled copy of the actual contract.
<br /> ■ �*The STATE SURCHARGE is.0005 times the Contract Price oc a mininautn,of$5.00.
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<br /> The u�dersigned hereby applies to the City �or issuar�ce of a�echanical Permit, agrees to do all
<br /> work in sfict accvrdance with tk�e vrdi�nances of tk�e City and the regu1ations o:F the State o�
<br /> Minnesota, and certifies t�,at all 'statezx�,ents m,ade or� this applieation are complete, true and
<br /> correct.
<br /> ,Ap�lican.t's Sigziature: � bate: ����'�Z
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