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09l30l2015 12:45 Riccar Heating �A?�}763 75A 0132 P.004l004
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<br /> ��`�t� a ,� 1�,� , . w, , , /�PrERiV�IT�'�E�CA LCU'L•ATT4N(S)�'�� r,,� �� � � s� . ey�� � �
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<br /> 1 S�� .n'' 'n. L .<., �, - �rBAS�ED_OFF. ,.2002 S:�'ATE�ST�ATLTE�. .,��s, ;,,� �.<t�,:;k�..� �^sb�
<br /> ❑ Yes,this section applies
<br /> The replacement of&Residentinl fixture or sppliance that meers a[1 three of the following requirements:
<br /> 1. Does not reyuire modificacion to elcctrical or gas service.
<br /> 2. Has a total coat of$5b0.00 or less;excludin�the cost of the fixture or appliance:and
<br /> 3. Is improved,installed or replf►ced by tho homeowner or licensed contracror.
<br /> Skip next section,if this applies; CosC of Permit $ 15.00
<br /> Stato Surcharge $ 1•Op
<br /> Mail-In Fee(I#'Applicttble) $ 2.00
<br /> Totnl Permtt Fee $
<br /> s�,b,��:.r :��-� '�a`,����r.�����c�c�r�:A��'arr s��,-:;ro�e' t�.ov�xF�$soo°:oo - . , ,{ . ,.,,.
<br /> If sbove does not apply;follow guidelines below:
<br /> _. ... ...... ... .
<br /> 1. �OtVTRACT PRICE *is T.25%of contract price with a(Minimum Fee of$50.00)
<br /> �C.P � x.0125$ ' 7��. a�s�
<br /> (ontract price) (mtnlmnm 550.00)
<br /> 2. 5TA'Y'�SURCHARGE
<br /> •.��, `��O .a`�o X.aoos s ��, o'�-/
<br /> (contract prica)
<br /> 3. POSTAGE&�I,NpLING(Only on Mail-Fn Applications) $r'� �J /
<br /> 4. TOTAL PERMIT FEE(Add�.ines 1-3 Above) $ / .
<br /> ■ * CONTRACT PRICE or 70B CQST means the actual or estimated dolaar amount charged for tho
<br /> permitted work including materials, labor�profit,and othor fixed costs. It is the amount to be charged
<br /> to the customer for the work done. ��'st�y material,equipment, labor or installations are furnished by
<br /> the owner, tonant or any other party,the reasonabte market value of such items must be added to the
<br /> estimated eost or eantract price for permit fee purposes. In the event th�t there is a dispute on the
<br /> amount of tho job cost,the City may requesE the su6mission o£a signed copy of the actual contract.
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<br /> ;, °;� ;, ��EC�:ANICAL�F$ '��p�YCATION:AG�tE
<br /> The undersigned hereby applies to the City for issuanc�of a Mechanical Permit, agrees to do aiI
<br /> work in str�ct accordance with the ordinances o�the C9ty and the regulations of the State of
<br /> Minnesota, and certifies that all statements made on this application are camplete, true aad
<br /> correct.
<br /> Applicar�Ys Signatur Data: 7-3�"� �
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