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OCT/28/2015/WED 01 :26 PM Heating & cooling FAX No, P 003 <br /> . , . <br /> . .. : ,- � ''P��Ul,iT:;�EE;��:� �'��.,- (�T�1�p . „. � . <br /> • � .�..,:..i}•.': `..�Y..'�•�: � .;�.. � �/,�. . <br /> . B�1i;C�D.QF��,-:�?�>S�?A��+�.T���.;. •, <br /> Q Yes,this section applies <br /> The replacement of a Residen' fix�ure or ' ce that meets alI three of the following requireznents: <br /> 1. es nat requi�re modificafiou to electrical or gas service. <br /> 2. Has a t cost of$500.00 or less;excIudin�the cost of tbe fixture or appliance:and <br /> 3. Is improved,instsl.led or replaced by tbe homeownar pr licensed contractor. <br /> Sl�ip next sec�ion,if this applzes; Cost of Permit $__ 15A0 <br /> State Surcharge $ 5.00 <br /> Mail-In�ee(Tf Applicable) $ 2.00 <br /> To#al Permlt�'ee s <br /> . P.��{'T F.�:E�CALCU�A ���: -��;�����..:�..� �.40':� � . . .. <br /> ) _ . �` =:::." �;. <br /> If abpve does not apply;fo�low guidelinas below: <br /> 1. CUNTRACT pItICE *is 1.25%of coutract price with a(Minimnm Fee of 550.0�) <br /> ��- 2.c�c� X.o izs$_ 5�.�. <br /> conti'act pricc) (mintmam 550.00) <br /> 2. S ��S�� G� �a�a <br /> �.000s s t� <br /> (coc�uact price) <br /> 3. P05TAG�&HANDI,.INCy(Only an Mail�in Applicatioc�s) $_ 2.00 <br /> 4. TOTAL PE�,t1ViIT�'E�(,q,dd Lines 1-3 A,bot�e) $ �/- �� <br /> * * CONTR.ACT PRICE or 10� C�9T means the actual or estimatad dollar a�ount charged far the <br /> perinitted work including materials,labor,profit,and other fixed costs. It is the amount to be cha�rged <br /> to the customer for tho work done. T�'auy material,equiipment, labor or installations are�ished by <br /> the owner,tonant or any other parry, the reasonable market value of such items xnust be added Co the <br /> as�i.m,ated cost or cantract price for�ermit fee purposes, In the evcnt that tk�ere is a dispute on t'he <br /> amount of tl�e job cost, the Gity may reqeiest the submission of a signed copy of the actual cvntrac� <br /> :;: ::11�lE�I�II�AL P'� .. :z.� �.�: ,:}.;�:., <br /> .iZ�til�' :;�;.: �?�.�. :�,,. <br /> ,�:. �,�T��:-:�r-�i:�:::;�;:.:t <br /> The undersigned hezeby apgIies to the City for issuance of a Mech&�ical Permit, a.grees to do a1] <br /> work in strict accordance with th rdinaxaces of the City and the regulatians of the Stato of <br /> Minnesota, and certi�'ies that a 'tate ents rnade on this �pplica�ion are complete, true and <br /> cOrtect. <br /> A�plxcant'sSignature: I��.S �� Date: / ������ <br /> � 3 <br />