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08/13/201� wED 10: 35 FAx 763 473 8565 S�bre He�ting 6 Air Cond 1�007/007 <br /> ❑ Yes,this seotion applies <br /> The replacement of a Rnsidential fiuture or anvlianCe that meets all three of the following requirennents: � <br /> 1. Doea not�equire modi�catinn to electrical or gas service. <br /> 2. Hss a to a of$500,4�or leas;excludi tha cost of the fxxture or appliance:snd <br /> 3. Is improved,inst�lled os repla,ced by the homeowner or licensed contractor. <br /> $kip next section,if this spplies; Cost of permit � 15.Q0 <br /> State Surck�stge S 5.00 <br /> Mail-In Fee(If Applicable) S 2.00 <br /> '['otxl l,'ermit Ree $ <br /> If abova does not apply;follow guidelines balow: <br /> 1. CONTItACT P`RIC� M ie 1.25%of contract price with a(Minimum Fee of SSp.00) <br /> �.I�O�. �6 __ X.oizss <br /> (Cont:act prica) (mlelmtl0s S3 .00) <br /> 2. �TAT�SURCAARGE <br /> �('�D 5�O I� x.0005 S � .�._.. <br /> ��o��t,��e� <br /> 3, POSTAGE&HANDT.SNC�(Only on Mail-In Applicationa) $ 2,Q4 <br /> rt. TOTAL PERMrr I�E�(Add Lines 1-3 Ahove) g � • <br /> • * CONTRACT PRICE or JOB COST means the actual or estimatsd dollar ainount charged far the <br /> permitted work including materials,labor,profit,and other�xed castv. It is the amount to ba t.harged <br /> to the customer for the work done. If any material, equipment, labor or installations are fumished by <br /> the owner, tensnt or any other party,tho reasonablo market value of�uch itema must be added to the <br /> estimated cflst or contract price fur permit fee purposes. In the event that there ia a disputs on the <br /> amount of the job cost,the City may requeat the submiasion of a signed copy of tho actual contract <br /> The undersigned hereby epplies to tha Ci1,y for issuance of a Mechenical I'ermit, agrees to do all <br /> work in strict sccotYlsnca with the ordinanoes of the Cify and tlte xogulationa of tha St�te pf <br /> Minnasota, and certifies that a11 statemants made on this appiica�ion ere complote, tnie and <br /> comect. <br /> Applicant's Signature: Date:�,�;l,�J'�1�� <br /> � � �� ,. <br /> 3 <br />