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0112412012 10:06 S R Mechanical �A�Q85�:i31A84 P.004l006 �-� FE�CALCULAT[ON�S) ' BA ��D FF- � � ST � E S � • [� Yes,thie section applies The replacematt of a Res�dential fbc or seel,�iance that meets aIl three of the following rdquirement�: I� L p�,�requiro modification to oleeaical or gas aervice. 2. Hae a�of SS00.00 or less;�jy�jQg the cost oF the flxturo or appltance:and 3. Is impcoved,inetallod or roplaced by ths horoeowner or lloonsed conaactor. 8kip next soction,if this applies; Cost of Permit $ ]S.00 State Swrcharge � 5.00 Mail-In Fem(lf Applicable) S Z.QQ Totsl Permit Ree S PBRMIT FEE C�►L.CULA�TJ01� S -JOBS OVBR.$�00.00 � lf ebove doea not apply;foliow guidelines below: 1. CONTRACT PAICE '�is 1,25°i6 of contrect price with s(Minimum Feo oP SSO.00) �w ' D x.01255 2�a� ( ntractprke) (miniroumSS0.00) 2. STATE SURCHARGE ��•�� x.0005 S �O� contrect pr ce 3. POSTAG�&HANDLING(Only on Matl-In Applications) $_ = 2,00 4. TOTAL PERMIT FEL(Add I.i�es 1-3,Above) $ � �- � ■ � CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the parmitted work including msterials,lebor,profit�and other fixed costs. It is the amount to ba charged to the customer�or the work done. If any material,equipment, labor or installations ara fumished by the owner,tenant or any other party�tbe reesonable market value of such items must be addad to the estimated cost or contract price for permit �ee purposes, In the event that there is a dispute on the amount of the Job cost, tbe City may request the submiasion of a signed copy of the actusl contract. MECHANICAL PERMIT APPLICATION AGREEMENT The undersigned hereby applies to the City for issuance of a Mechanical Pennit� a�rees to do all work in strict accordance with the ordinances of the City and the regulations of the State of Minnesota, and;,�eyrtifle t all staternents made on th�s application are complet�e, tcue and COrtCGt. ` ; Arrlicent's Signature: +"�'�• �ate: � ''�`� '1 Reset Form 3.