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03/17/2015 TUE 12: 27 Fax 763 G73 8565 Sahre Heating � Air Cond �007/007 <br /> a. <br /> T ' _. ... <br /> ❑ Yes,this se.ction ap��aiea <br /> Tha replacemerat oF a Ii�. ;�idential fixt�re or a�jj��that maete all three ot d�e following requiramenb: <br /> 1. baes nat require modifiaadon to alectrical or gss service, <br /> 2. T-�as a total cost of$SDOA�or less;�xcludjng the cost of the fixtute or appliance:and <br /> 3, Is improved,installed or replaced by tho homeowner or licansed contractor. <br /> Skip next section,if this appliey; Cost of Permit $ 15,Q4 <br /> Stdte Surcharge $ 5.00 <br /> Mail-In Fea(If Applicahle} $ 2,4Q <br /> Total Pe��mit Fee S <br /> � If above does not apply;follow gu�delines below: <br /> 1. CONI'RACT�RTC,� "is 1,25%of contrsot p��ice with a(Minimum Iree of�50,00) <br /> I —1��`"�b� -- x.012S$ �, �c�']� ' �D <br /> (conVeat pnco) (minlmum SSR00) <br /> Z. �ATE�URCAARGE �. I S/ <br /> (����5�.,(�� _x.0005 $ <br /> (conUact pricc) <br /> 3, POSTAGE&HANDLIN'G(Only on Mail-In Applicatioras) $ ..._..___ 2.00 <br /> -, . (�� <br /> 4. TUTAL PEItMIT F��(Add Lities 1-3 Abwe) S,_,_ ��� `��� <br /> ■ "' CONTRACT PRICE or JOB COST means the actual or estimated dallar amount chargad for the <br /> pemnittad worlc including materials, labor,profit,�nd other fixed costs. �t is the amount ta be char�ed <br /> to the custAmer for the work dono, IF any inaterial, equipment, labor or installaUons are furnished by <br /> the owner,tenant or any other party, the reAsonable market va�ue of such itams must ba added tv the <br /> astimatad cost or contcact price for permit f�e purposes. In the e�ent that there is a dispute on th� <br /> amount of the job cos� tho C�ty may requcst the 9ubmiseion of a signed copy of the�ctual contract. <br /> The uz�dersigaed hereby applie9 to the City for issuance of a Ivagchanical Pemzit, agrees to do all <br /> work in strict accordance with the ordi�nancos of the City and the regul�tions of the State of <br /> Minnesotr� and certifias that a�l statements made on this application are complete, trus and <br /> correct. <br /> Applicant'sSignaturo; �p, Date: �-1'j:.,Z01� <br /> j, � '� <br /> 3 <br />