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�4/�5/2010 03:09 9529222434 SAYLER HVAC PAGE 04/04 <br /> „ I IFl �N.a I P�L r�l J �; �7n��1'.L 1'-�L7������1J�le l � . <br /> � �' —s 'Y 1� F: <br /> aV��t���?iw d 1��+��dR71el i �� . � .,, � „� <br /> _ },� a�r�'��!`���:"; z{1��-�'T�.��'�-�.-�`�� '' r:_ :. <br /> �� <br /> 4 <br /> ❑ Yes,this section appiies <br /> The replacement of a Residential fixture Qr appiiance that meets all three of the£ol1owit�g requirements: <br /> 1- 17oes not require modi�cation to eleCtrical or gas service_ <br /> 2. Has a t ta of�500.00 or less;exc1udina the cost of the fixture or appliaqce:a�d <br /> 3. Js improved,installed o�replaced by the hotneowner or licensed cantractor. <br /> 5kip next section,if this applies; Cost of Pennat $ 15.00 <br /> State Surcharge $ 1.00 <br /> Mail-In�'ee(If Applicable) $ 2.00 <br /> Tota1 Per►t��t k'ee $ <br /> u������a��,r r � _._. �� __ " , i����F e y ,���. <br /> rl�,1!�����v�N��� �9� �J'_;_._ . ��� �i�r ��,t���!'.'a`��I{i'h4��IFni !�B a�u➢�"vB,��� <br /> If above does not apply;foliow guidelines below: <br /> 1, CON ' is 1.25%of contract p��ice witlf a(N�inimum Fee of�50.00) <br /> ZSL�U X.0125$ ��OU <br /> (contt�tct priCe) (minimam SSO-00) <br /> 2. STATE SURCH,ARGE <br /> ^ �S�Q x.0005 � 1�2� <br /> (contract price) <br /> 3. POSTAGE&HANDI,ING(Only on Mail-In Applications) $2_00 <br /> 4. TQTA,L PERMIT FEE(Add Lines 1-3 Above) � <br /> • '' CONTR,�CT PRIC� or JOT3 COST means the actual or estirriatcd dollar amount aharged for the <br /> permitted work including materials, labor,pro�t,and othcr fixcd costs. It is the amount to be ct�arged <br /> to the customer for the work dona If any material, equipmeqt, labor or it�stmalations arc fumishcd by <br /> the owqer, tenant or any other parEy, the reasonable market value of sactc itcros must be added to the <br /> estimated cost or contract price for pe�7nit fee purppses. ln the event that there is a dispute on tt�e <br /> amount of the job cost, the Ciry may request the submission of a signed copy of the actval contrack. <br /> ���Fs�H� �, e }y �� _ <br /> ..;:y� i 7 a•bf6, r ���,. '. .:� y'. , "�7�9'��{��" h.�.;�(� ,;�..�� C., ,o`;�x� i, Yp'.:,�e�.,i it�' �'�!1'R'; <br /> r f ,k>;�!.��._-��� �"� <br /> The undersigned hereby app�zes to tbe City for issuance of a Mechanical Perrnit,agrecs to do all <br /> work in strict aecordance with the or•dinances of the City and thc rcgulations of the State of <br /> Minnesota, and certifies that all statements made on this a�?plicat�or� are eprnplete, true and <br /> cot�c•ect. <br /> Applicant's Signature: Date: 9-�$"-1� <br /> 3 <br />