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06/28/2612 11:93 9529222434 SAVLER HVAC PAGE 04/04 <br /> - -��,*� �-�-�3�.: -_ . t ,�.. ,� �. � ,.�,, <br /> `� +��/.,�. � s�'X.�� ' 7k' � : t � ��•.r b ',�� r �•'ta � -��Q> ��:H, . <br /> '""�[{Y'^P _{'.. �., - ' J./u���c.�" � �`? <br /> ^.�.�'k-+(�0�S l N � IwT _ 1+ ' Y,� �i.'4 `� P <br /> .�' vVA�t� w �.t z ) ' - �0 �v..m.. <br /> ❑ Yes,this section applies <br /> Thc rcplaccment of a e 'de tial fixtarc or ' ce that meets al I three o�the following requi�cements: <br /> �. Does noc require modification to electrical or gas service. <br /> 2. Has a t 1 c st of$500.00 or less;e c ud'n the cosc of che�jxture or appliance:and <br /> 3. Is i�mproved,installed or teplaced by the homeow+�er or licensed contractor. <br /> Skip n,ext section,if tk�is appl�es; Cost o�Permit $ 15.00 <br /> State Surchafge $ s_oo <br /> Mail-!n Fee(1�.A,pplicable) $ 2.00 <br /> Total�ernait�ee $ <br /> If above does not apply;follow gvidelines below: <br /> 1. CONTRACT PR10E *is �25%af contract price with a(Mlnlmum k'ee of$50.00) <br /> ti?A�Oc7 �_Oa25$ ��OU <br /> (Contcact price) (minimum$50.00) <br /> 2. STATE SURCHARGE <br /> �iLa=ot� X.000s $ •ti� <br /> (contract price) <br /> 3. POSTAGE&HAND�.ING(Only on Meil-�n Applications) $ Z.00 <br /> 4. TOTAL R�KMIT FEE(Add Lines]-3 Abave) $ SZ•`�� <br /> ■ * CONTRACf PRICE ox JOB COST areans the actual or esti�mated dollar amou�t charged for the <br /> pernutted woirlc in�c�udi�ng matorials,labor,profit,and othe��xed costs. It is tk�e amount to be charged <br /> to the custotner for th�e work done. If any material, equi�ment, labor or installations are furnished by <br /> the owner,tenant or any other patty,the reasonable nnarket value of such ite�ns must be added to the <br /> estinnated cost or contract p�ice for permic fee purposes. In the event that there is a dispute on the <br /> amount of the job cost,the City may z'equest the submission. of a signed copy of the actual eontract. <br /> The undersigned hereby app�ies to the City for issuance of a Mechanical Permit, agrees to do all <br /> work iz� striet accordance with the ordinances of the City and the regulations v�t�;e State of <br /> �i�zu�esota, and ce�ti�es that all staterx�e�nts made on t�.is applieation are co�nnplete, true and <br /> conrect. <br /> � <br /> fi' <br /> Applica�.t's Signature: l" pate:�2'Z '��''►L _ <br /> ��`����,.-,.v �- : <br /> „���, ' ay_���� .,�:::�a�s�.: <br /> � <br />