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06/18/2415 THU 12:Q3 FAx 763 473 8565 Sdbre Hedtinq & Air Cond f�007/007 <br /> [] Yas,this section applies <br /> 'Z'ha replacem,ent o£a Rasidantis.[ffxtura or applianc,�that meets all three o�tha follawing reryuiremeats; <br /> 1. boes no require modi�ication to alectrical o�gas service. <br /> 2, Has a tntal cost of�900.00 ar less;excl ' the cost o�tha fixture or appliance:and <br /> 3. Ys improved,installed or replaaed by the homeowner or licsnsed contractor. <br /> Skip next section,if this applies; Cost of Permit � 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total rerm;t Fee s <br /> If abova doee not apply;follow guidelines below. <br /> 1. CONTRAC'I'PRICE *is 1.Z5%of contract price with a(Minimum Fee of�50.00) <br /> � ���Q�.U�-- - x.01255 . <br /> � (aontraotprice) (minlmum660.0 <br /> 2. �7'AT'E SUItC�GE <br /> _.,�,�'�`t q_1-bo x.000s sl.,. I z Ao <br /> � ���t p�) <br /> I 3. Y'OSTAGE&HANDLING(Only on Mait-In Applications) $ 2.00 <br /> I <br /> 4. TOTAL PICRMT�'FT�(Add�,ine�1-3 Above) � '�3�.ZT <br /> � • � CQNTRAGT FRICE or JdB COST meana ihe actual or estimated doltar emount cherged foc tha <br /> , permitted wotic including�nnaterisls,labor,profit,and orher fixed costs. It i�the amount to be charged <br /> to tha eusWmer for tha work dona, If any material,equipmenC,Iabor or inatallstions are fumiahed by <br /> ' the owner, tenant or any other party,the reasonable miar�Cet value af such itema must be added to the <br /> estimate@ ccRt or contract price for permit fee purposes. In ihe avent that there ia a dispute on tha <br /> amount of tha job oost, d�e City may requost the subntission of a signed copy of the actual contract. <br /> i <br /> The�u�dersigned hereby spplias to the City for iasuance of a Mochanical Pernut, agrees to do all <br /> ' wprk in skrict accordance with the ordinances of tha City and the regulations o�th,e State of <br /> Minneaota, and certifies that all state�nnants made on this application are complete, true and <br /> C417eCt. <br /> A.pplicant's Sigx�ature: �v� ��IUiI� 17at�: �/•��•�/5 _ <br /> , <br /> � 3 <br /> i <br />