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Oz/02/20i5 MOx ia: 5a FAx 763 a73 8565 Sdbre Hpating & Air Cond f�00a/007 <br /> I <br /> � • <br /> r <br /> � i <br /> ❑ Yes,this section appliea <br /> Tha replscement of a Rasidantial�re a p lir� ance that maets a11 thrae of the following re�uirementa; <br /> 1, Doea o raquire modifica,tion to electrical o�g�9 service. <br /> 2. Has a total cast of$500.00 or less;excludin�z the cost o�tha fixture or appliance:and <br /> 3, Is improved, instaIled or replaced by the homeowner or licenaed wntrscfor. <br /> Skip next 9ecti�n,if th;s applias; Cost of Permit $ 15.00 <br /> State SurChargO $ 5.00 <br /> Mai!-In Fee(if Applica6le) S 2.00 <br /> '�otnl Pe��mit Fee S <br /> If above doas not spply;follow guidelines below� <br /> 1, *is 1.25%of contract pzice with a(Minlmum Ree of SS0.00) <br /> � ,���j.b� x.0125� <br /> � (oontraol priee) (minlmum 550.00) <br /> 2. STATE SURCAARGF <br /> 1�{�5 •DO --_�K.aaos $ ��l <br /> �o����P��� <br /> 3, POSTAGE 8c HANDLING(Only on Mail-In Applications) $ �.44 <br /> 4. T�'Y'AL PEANIIT F'I�E(Add Liues 1-3 Above) S ����� <br /> ' � " CONTRACT PR�CB or JOB COST means the actual or estimated doUar amonnt charged for the <br /> permitted work including matarials, labor,profit,and other fixed coats. It is the amount to be char�ad <br /> to the customer for the work done, If sny matarial, equipm�n� labor or installationa �re fumiahed by <br /> the owner, tenant or sny other party, the reasonabla merket value of such itama muat be added to the <br /> estimated cost or co�ntract price for permit fee purposes. In the avant that there is a diapute on tha <br /> amount oF the job cost,the City ►nay request the submission of e signed copy of the actual contract. <br /> The undersignad 1leroby �pplxes to tl�a City for isauance of a Machanical Permit, agrees W do all <br /> � work in s�ict accordence with the ordinances of the City and the regulatioz�s of the State of <br /> Minnesota, and cartifios t�at all stateme�ts made on this appliaation arg complete, true and <br /> correct. <br /> Applicant's Sign&turo; i,—���„�( Date; x.'��'�.Q�� <br /> , <br /> I 3 <br /> � <br /> I <br />