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11/17/2015 TUE 1a: 31 FAx 763 a73 8565 Sdbre He�tinq b Air Cond �40a/004 <br /> � <br /> ❑ Yes,this section�pplies <br /> 'fhe replacement of a$ssidential fixtura or aonliance that meets all three of the following requirements; <br /> a. not roquire modification to electrical or gas sarvice. <br /> 2. Has a tofal cost of SS00.00 or loss;g�y�jpg the cost of the�Mture or appliance;and <br /> 3. Is improve�installed or replaced by the homeowner or licensed contractor. <br /> . ._.. _.__ _ _�,,. __.___.. . <br /> .. . . . .. . .. <br /> Skip next section,if this�pplies, � �ost of Pern�it � � $ � �15.00 <br /> 3tata Surcharga $ 5•00 <br /> Mail-In Fee(Tf Applicable) � 2.00 <br /> Total Permit Tee S <br /> Jf above does not appl�+;fotlow guidelines b41ow. <br /> 1. CONTRACT PIt10E * is 125%of con�act price with a(Miaimum Fee of SS0.00) <br /> 33A�.nn �.o�as� �o.n(Z_� <br /> (oontract price)' (mltiiwum S90.00) <br /> 2, �TA'I`�SCIYtCHARG� <br /> 3 3�5.ou X.000s � I��0 <br /> (��n�) <br /> 3, POSTAGE&HANDT,TNG(Only on Mail-In Applicat�ons) $ 2.0� _ <br /> , 4. TO'�'A�,PPRNIIT FE,�(Add Lin�s 1-3 Above�) S �J�•�� ,,, <br /> � � " CONTRACT PRIC� or JOB COST means the aciva.l or estimated dollsr aneount charged for the <br /> � permii#ed work including matarials,Iabor,profit,and othar fixed costs. It is the annount to be cbarged <br /> I to the c��stomor for the work done. If any material, equipme�rt, labor ar installations are furniahed by <br /> ' the owner,tenant or aay other party,ihe�easonable market value of such items r�wat be added to the <br /> estimated cost or contract price for pennit feo purposas. In the a�vent that there is a dispute on the <br /> sxr�ount of tho job cost, tho City may request tha submission of a signed copy of the actual contract, <br /> The�u1dorsigned hereby applies to the City for issuance of a Mechanical�'err�it, a�'oes to do all <br /> work iu slrict accordancc with tho ordir�ar�cos of tkxo C�ty and the regulatious of die State of <br /> Minnesota, and certifies that a11 statements made on tlus application are complete, ttue and <br /> ' COfTCCt. . <br /> � <br /> Applie�az�,t's Signat�u-e: � Date: �,��� �"����� <br /> � 3 <br /> i <br />