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OCT/12/2015/MON 01 : 10 PM Heating & cooling FAX No, P. 004 <br /> �� '' ' �; �'�R11�{IT F'EE�.AL�+�'��f.�l�T(�,� ; ' <br /> . . a �, . ... : : <br /> . ,; , :.;, <br /> > . . . �; : . �.:.�AS�I�O�F �002 ST�1;�'E�.TA''I,'�7'� :::: . :,:� . . . . .. . . <br /> [� Yes,this section applies <br /> . The reptacement of a:Residential•fixture or a�piiance that meets all three of the following requirements: <br /> 1. Does not require modification to clectrical or gas service, <br /> 2. �-Tas a t l.cosk.of$500.00 or lesa;excludine the cost of the£'ixture or appliance:and <br /> 3. Is improved,installcd or replaced by khe homeowner or lieensecl eantractor. <br /> Skip aext section, i£tb,zs applies; Cost ofpermit � 15.00 <br /> State Surcharge $ t.00 <br /> Mail-�Fee(If Applicable) $ 2.00 <br /> Total Permit�ee S <br /> . ,.. . . . <br /> �� . ��R1V��T:�'EE.CAZ�U��'Xf}N'��S '� O��`EkVE�t:���Q�4Q t _.. <br /> .�` " �`'a:�:'�,:.>:-�; <br /> R �:� .:•�s�:, <br /> I�above does not apply;follow guidelines below: <br />- - - 1. CONTRAC Y"��C� +is 1.25%of con�racf price with a(1Vliniiriam Fee oi 550.00) <br /> �3,�'o� �c.ozzs� !"d�7 �' <br /> (contract price) (min�mum�so.o0) <br /> 2, STATE SURCHARGE o <br /> ��,$'a� _x.0005 $ �/ r"" <br /> (connncti prico) <br /> 3. POSTAQE&T�ANDLiNG(Only on Mail-In Applications) $ 2.00 <br /> � �° <br /> 4. TQT'AL PERIVIIT FEE(Add Lin�s 1-3 Above) $__._�¢�/ ____ <br /> ■ �` CONTRACT PRICE or JOB CbST mcaas the actual or estimated dollar amount eharged for r,he <br /> permitted work inctud�ng materials, labor,profrt,at�d ocher fix�d costs. It is the amount to be charged <br /> to the customer for the work dono, If any mateiial,equipment,labor or installations are furnished by <br /> the awrler,tenant or any other party,the reasonable market value of such iteYns muat be added to the <br /> estimated eost or contract price for permit fee p�arposes. Tn the event that there is a dispute on the <br /> amount of the job eost,the City may xequest the submission af a signed capy of the actual con�act <br /> ��` ' � �"; °:.` :��:I��1ECT�A�ICA�T,��ERl1��T�.�PPL�CAZ'TON:ACR��EMEl'J'I'.....:...... :.:.::':;...:':.,:. ': <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permi.t, agrees to do all <br /> work in strict accordance with the ordinances of the City and the regulations of the State of <br /> Minnesota, and certifies that all statements t�i.ade on this application are camplete, trae and <br /> correct. <br /> Applica.nt':s Signature: � �"s�f Dat�: �o--���--- /� <br /> . 3 <br />