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01/06/2015 15:13 7634987618 COMFORT MATTERS HTGE PAGE 04
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<br /> ❑ Yes,this section applies
<br /> The replacement of a Residential fixture or ap�liance that meets all three of the following requirements:
<br /> 1. Does not require modification to electrical or gas service.
<br /> _ 2. Has a totai cost of$500.00 or less;excludine the cost of the fixture or appliance:and
<br /> _ . 3. Is improved,installed or replaced by the homeowner or licensed contractor.
<br /> Skip next section,if this applies; Cost of Permit $ 15.00
<br /> State Surcharge $ 5.00
<br /> Mail-tn Fee(If Applicable) $ 2.00
<br /> 'I'otal Permit Fee $
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<br /> If above does not apply;follow guidelines below:
<br /> 1. CONT'RACT PRICE *is I.25%of contract price with a(Minimum Fee of$50.00)
<br /> �1 jfcy� X.o�25$ i �g� b�
<br /> (contract pricc) {minimuar S50.00)
<br /> 2. .STATE SURCHARGE
<br /> ���b�� x.0005 $ �.`acs�
<br /> (contract price)
<br /> 3. POSTAGE&HANDLING(Only on Mail-Tn Applicafions) $ 2.0�
<br /> 4. TOT'AL PERMI'I'F'EE(Add Lines 1-3 Above) $ I H S. ��
<br /> ■ � CONTRACT PRICE or JOB COST means the actual or estimated dollac amount charged for the
<br /> pennitted work including materials, labor,profit,and other fixed costs. lt is the amount to be eharged
<br /> to the customer for the work done. If any material,equipment, labor or instatlations are fizrnished by
<br /> the owner,tenanY or any other party,the reasonab[e market value of such items must be added to the
<br /> estimated cost or contract price for permit fee purposes. In the event that there is a dispute on the
<br /> amount of the job cost, the City may request the submission of a signed copy of the actual contract.
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<br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, 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 made on this applicatian are complete, true and
<br /> correct.
<br /> Applicant's Signature: _ Date: �/� /�
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