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i0/06/zDia KON 1a: 08 FAx 763 a73 8565 6abre Henting 6 Atr Cond �00z/OOa <br /> � , . . <br /> ❑ Yes,tltis section applies <br /> The replscement of s$&,�jdAntial fixwre or a l�y�iance that meets sll three of tl�e£ol�owing requiraan�ts: <br /> 1. boes not require modifiaadon to eloctrical or gKs service. <br /> 2, Has a�t�uf a500.OQ or less;exaludin�the cost of tha�xture or applisnco:snd <br /> 3. Is improved,installed or replaced by the hosneawuer or lipensed contractor. ' <br /> Skip next sectior�if this spplies; Cost of Permit ffi 15•OQ <br /> Stau Surcharge S S•00 <br /> Mail-In Fee(Tf Applicabla) S 2.U4 <br /> Tot�l Permit�'ce S <br /> If above does not appty;follow guidelines below: <br /> 1. "'is l.25%of contract prica with a(Minimum Fee of 530.�) <br /> x.01255 ��� <br /> (cqptrect price) (mlalmulu S50.00) <br /> 2. ST <br /> �. •�� x.0045 S �'� <br /> (crn,lract priae) <br /> 3. POSTAGE&HANDLING(Only on M�ail-Tn Applications) S_ ,, 2 b0_,,, <br /> 4. TOTAL PERMI'r�'EE(Add Lines]-3 Above) S 3,`�� <br /> • " CONTRACT�CE or 70B COST m�ns thc actual or�timated dollar amount charged for tho <br /> pearniitted work including matarials,labor,pro�it,and other fixed costs. lt is tho$r�nount to be charged <br /> to the customec for the work done. lf any material,equipment,labor or installations sra fi�mish�by <br /> the owner, tenaut or any other party,the ransonable markat valuo of suoh iteans muat be added to the <br /> estimated cost or contract price for permit fee purposes. In the event thet there is a dispute oa tha <br /> amour�t of the job cost, tho City may reque�t the gubmission of a signed copy of the actua,l contc�ct. <br /> Tha undersigned hereby applios to the City for issuance o�a Mechanical�ormit,agreea to do a11 <br /> work in strict accordance with the ordinances of the City az1d t�s regulations of the State of <br /> Minnesota, and certifiea that all statemarifs made on this application are complete, true and <br /> con'ect, <br /> Applicanl's 3ignature: � A! Date:, ��'�0'�1�`f' <br /> � <br /> � <br />