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05/18/2017 TxU 13: 01 Ft�x 763 673 8565 8abre xeating & Air Cond �007/007 <br /> ❑ Yes,ihis SeCtion appiies <br /> '1'I�e replacemenr o('a Ttc_sidrntial fixtttre or al���li.anc�'•,thak ntc�.e,1,s ail ilu•cc o;f the�'ollowing rec7uiremezits• <br /> 1. 17aes nqt rex�uire n�(u3i{�icatinn tn electrical or�as setvice. <br /> 2. Y3as a to�a�of$500.00 or less;exeludin¢the cost of the fixture or appiiance: and <br /> 3. Is improved, inst,�lled or re{�laced by thc homc.owncr or licensed contractor. <br /> ---�----•-----�------�-------.p----._. ....__,_.,.. <br /> Sk� ncxi section,if this applles; Cost of Pemut � $ � 1�,�Q ��� <br /> State Surcl�arge � 5,00 <br /> Mxil-It�Tee(�E'Applieablo) � 2.�Q <br /> rorai Perm�t]�cc $ <br /> If above does not appI�;follow guidelines below: <br /> 1. CONTRACT MtIC� *is 125%of contract price with a(1V�inimu�n T'cc of 550.40) <br /> , ZO 3�5•O't7------ x.oizs� 25�• lo� <br /> (oontrnccpric,o) (�inimum 558.00) <br /> 2. STATE SURCI�ARGE <br /> ---�...�� J7�J•0� _x.0005 $ �O•�� <br /> (aonuact prioe) . <br /> 3, ):"OSTAGL dt I,LANDC.,ING(Only on h�ail-T.n Applications) $ __2 U� _ <br /> 4. TOTAG 1'�I'FCL(Add Lin�s 1�3 Above) � _ _z_�/•,�� <br /> ■ " CON`1RACT pRICH or J033 COST means the atitual oi estimated da118u' tutlout�t charged for t4�e <br /> permitted work inctudi�ig t»,aterials,labor,profit,and oth��xed costs. It is the amount to Ue cl�'god <br /> i�o tl�e customer foc the work done. If any material,equipment, labor or iinstallatians ac�fumishad by <br /> . tho owner, tenant or a� other paity,the reasonablo market va.lue of such itcnns must be addod to cho <br /> estimated cost ar c�ontxact price �'or peim,it fee purposes. In the event that thero is a dispute an the <br /> . amou�o£tt�c aob cast,4e City may requcst tl�e subm.ission af a si�ned copy of the actual coniract. <br /> 'I'kie uz�,ders�gued liereby applies to tlie Czty for issuance of a Mech�nical Pemiit, agrees to do all <br /> work in strict accordsnce with the ordinances of t�e Cily xnd i�ie regulations of the State of <br /> Minnesot� and certi�es that all stateme�n.ts made on tlus application, are camplete, true and <br /> cozrect. <br /> Applicani's Signature; �/)la�� l�ate� 'rj"l.�,',;•7r.(��� <br /> 3 <br />