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05/27/2011 07:4� FAX 7694283682 HEATING AND COOLING TWO �004
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<br /> ❑ �'cs, tl�is secCion applies
<br /> T}1C l�eF11�CClll�ll(UP il RL'S1dC11C111�1\LUI"C Ol�a �liancc that xneets all tb,tee of thc followin�requicements:
<br /> 1. T�oe.s not require c7,udiGcation to elecn�cal or gas service.
<br /> 2. Has a total cost uf$500.00 0�'lass; cxcludii� lhc cost of tl�e f�ture ur a��pliancc; ancl
<br /> 3. Is irnpro�cd,installed or replaced by the homeowner or Iice��sed conh•actor. �
<br /> Skip next section, if t��is applies; Cost of Pernut $ 15.Q0
<br /> Scatc Sut'chsrge $ ,,,____ .50
<br /> Mail-In Fee(Tf ApplicaUle) $ _I.�p
<br /> I'otsl Pertxlit�'ee $
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<br /> IF above does not apply; follo�v guidclin.es Uelow:
<br /> � 1. CONTR.ACT�'RTCE * is 1..25% of conh�act priec with a (Nlinimum�+cc of$35.00)
<br /> _ ��. X.o�zs $ 2l� .��
<br /> ontr ctprice) (minimum�35,00)
<br /> 2. S1ATE SUl.2CTTARGF **Add rhe Sta[e Blclg Cade l�iv, S�uchaT�Je(Nfinimum Fee oi$S�1)
<br /> x ,0005 � O� ?�
<br /> (contract pricc) (minimum$ .50)
<br /> 3, POSTnGF&�It�NDLING(Only on Mail-In Applications) $ 1.50
<br /> 4. 'COTAL PERMT'1'FEE(Add Lines 1-3 I�Uove) $ ��(D � ��
<br /> ■ * CONTRAC'1' pRICE or JOT3 COST means the actual or esrimated doll�tr amount cbatged for the
<br /> permittcd work including materials, labox-,pTofiC, and otl�er fixed costs. It is the am�unt to be chai;ed
<br /> to tl�.e customer for ttic work done, Yf any rnaterial, equipn�ent, labor or i��stallations arc: furnish�c by
<br /> tl�c owner, tenant or �ny othcr party, tl�e rcasonable market valu.e oF such items xnust be added to the
<br /> cstix�ated cost or con,tr�ct pri�c foz pernut f�e purposes. In t1�,e event chat there is a dispute on the
<br /> amvu�lt uf[hE job cost, the Cily may .�eques4 the submission of a si�ned copy oE the actual cot�tiac�;
<br /> ■ "'*The STA'�1 L SURCHARCr�is .0005 o.f the Buildu�g Depsztzncnt at(952) 2�9-4600 far the price
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<br /> The undersigned heXcby ap�iies to the: City fur issuance of a Me�hanical Permit, a�ecs to cic all
<br /> work in strict aecordance wilh the o►-dinanc�s of the City and the re�ulalions of the StatE of �
<br /> Mi�nesota, and ecrliFies that all statem�nts macle on this application are complete, true ind .
<br /> correct_
<br /> Applicant's Signa�ure� _, Date: �Z��_
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