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01/31/2p17 TUE 8: 59 FAx 763 a73 8565 Snbre Hesting & Air Cond �OOa/007 <br /> ❑ Yes,this section app(ies <br /> Tl�e replacament of��gga� 'g��al fix�,�ig 4T„�pDliance that meets all threu of tlie following�equiret�ents: <br /> l. Does not require modificatipn to electrical or ges servico. <br /> 2, I3as a total cost oE�560A0 or fess;g�i jag the cost of the fixture or appliance:and <br /> 3, Is improved,iostalled or replacect by the homeown�or licensed coatractor. <br /> �� � .. .. .. .._.. Skip next seation,i£this applies; Cost of Pem�it $ 15•QO '— . .. <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) �,� 2.00 <br /> Total permit Fee S <br /> If above dves not apply;follQw guidelines below: <br /> l. CONTRACT PRICE "is I25°/a of cantract price with a(Minimum�'ee of�50.00) <br /> � �l a10 AO x.Ol2S� �Z."]�.�( <br /> (canl�actpriae) (1nEnlmum S�U.00� <br /> z• �T��r��Ult�(�tG� � 1p, <br /> - - W--�11--�•oo x.odOS � ��•q�p <br /> c���tp�� <br /> - ----- <br /> 3. Pt7STACrE&I3ANDLING(Only on Mail-In Application�) S 2.00 <br /> 4. TOTAL PEAMIT P"EE(Add Lines 1-3 Above) $ <br /> ■ * CONTRA.CT�'ItIC� or JO� COST means the ach,al or astimxted dollar amount ct,arged for the <br /> permitted work including matorials,labar,profit,and other fixed costs. Yt is the annount to be charged <br /> to the customor for tha work done, Yf any matarial,equipment, labor or installations are furnished by <br /> the rnmer, tensnt or any other party,the reasonablo markot value of such items must be added to the <br /> estimated cost or eont�act price foe pem►it fee p�uposes. In the ovau thet th�re is a di�pute on the <br /> nmo�mt of the job cost,the City may request the submission of a si�ncd copy of she acxual contra�t. <br /> The undersigned hereby appliea to the City for issuance of a Mechanical Pormit,agcces to do aU <br /> � work � sbrict accordarice with the ordinences of the City a�d the regulations of the State of • <br /> Minnesota, end certifies that all stateme�rts made on tk�is application are complete, tnte and <br /> cortect, <br /> ' Applicar�,t's Signature: 1/ babe: �' ��• .�01� <br /> I � � <br /> 3 � <br /> � <br />