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OCT/07/2015/WED 01 ; 02 PM Heating & cooling FAX No, P. 004 <br /> � , . , . : - . A,,��_��;�. � .. . . . <br /> . /• . ,y"r;�'�I� ��', . . <br /> .' : ,.,��+ , . (1 �Y .1� �..,•, <br /> ' ' �+-.stiT���1'�'.":�w7�'f".+47����A7'3�T,S'j i'9'L'I' . . . . <br /> ❑ Yes,this sectioa applies <br /> The replacement of a R sidential fi e or s liance l�at meets all three of the following requirements: <br /> 1. Do�not require uaodifica�io�s to electrical or gas service. <br /> 2. Has a total�ost of�500.00 os less;excludine the cost of thc fixture or applianco;and <br /> 3. Is improved, installed or replaced by the homeowner or lieensed caa�tractor. <br /> S�p n.ext section,i�this applies; Cost of Pc�rm,it S 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $� <br /> Total peraait Fee S <br /> � � PF:1211�{T FE� �i.�CUT:,A�..: _ B�:: '��.O�:�Q`.; .. <br /> If above docs mot apply;folldw guidelines belpw; <br /> 1. CONT'ItACT P1tYCE *is 1.25%of con�act price with a(Minrmum Fee oi 550,00) <br /> / ��C� x.01255 dt7 <br /> (condact price) (minimum SSOAO) <br /> 2. STAT� URCI�AA ��/ <br /> ��Z7 x.0005 � lp i O� <br /> CotltraCt pria) .�.. <br /> 3. POSTAGE e�.HANbT.ING(pnly on Mail-In Applications) $_ 2.00 <br /> 4. TpTAL PERM�T FEE(Add Lines i-3 Above) $ ���, � <br /> ■ * CONTRACT pItIC� or JO� COST means the actt�al or estimated dollar axnotimt chsrged for the <br /> permitted work includiag materials, labar,pro$t, and other fnced costs. It is the amount to be c�aa�rged <br /> to the cust4mar for the wor�C done. If eny mar.erial,equipment,labor or installations are finnished by <br /> tiae owner,tena�Y or any other party,#he reasonable xnarket value of such itenus must be added to the <br /> estimated coat or eontract price for pernut£ee purposcs, In the avent that thcre is a diapute on the <br /> amount of the job cost, thc City may request tl�e submisaion of a signed copy of the actual coatraet. <br /> ro .:Av.�Ji �11L"ll�ll(!�j�S�� '� y7e� � 'C��•'�iFf�-'�' M r'' "r;�•."; <br /> "�1`!'+4�'. ,.x.. �'. �J, �.y%.;.''��.;.';,...',..:. <br /> .,:+,.w.%-.: , ;,�a.-�:��� <br /> The undersigned hereby applies to #�e City for issuance of a Mechanical Permit, agrees to do all <br /> work in strict accordance with the ordinances o:F tho City and the regulations of the State of <br /> Mu�nesota, and certifies that all statements made on this applicatian aro complete, txue and <br /> corrxt. <br /> Applica.rxt's Signature�� pa�•�Q ���� <br /> . � <br />