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07/25/2017 TUE 8: 32 Fnx 763 a73 8565 Sebre He�ting & �►ir Cond f�007/007 <br /> �] Yes,this seci:ion applics <br /> The rcplacemern qf a R.esidei�,,,�ture or a�pliance that mer�s all threc of ihc follov,+iag rec�uiren�,ent�: <br /> 1, Uoes not roquire n,odifieation to electrical or gas service. <br /> 2. I3as a total eost af$500.00 or less;excludit7�h t17e cost of tIie ftxtuTe or applixnce: and <br /> 3. Is improved,instailed or replacEd by the homeowner or lieensed contractor. <br /> --- ---._ .,.-- --------- Skip next section,if this applies; � Cost of Permit----y---.�,T.T� $� . 1,�,b� —_,..-.._._—. <br /> Staie Surcl�arge $ 5.00 <br /> ivJail-Xn Tee(�f ApplicaUle) $ 2.00 <br /> Toial Pc.+•mit�+ee S <br /> if al�ove does not app]y;�'ollow guidelines below: <br /> 1. COlV1'RACT p1tYCE "'is 1.25%of s,ontraa p�iae with a(1VCini�►�un�Fee af 550.00} <br /> . � 3 x.012SS � ���1p .. <br /> (pp�p«p�,�) (Ntinimnm SSQ00) <br /> 2. 5"I'ATE SCIItC�iARCE <br /> x A005 $ �1•�J� <br /> _ ��� ...— , �� <br /> 3. POSTAGr�&�TAI�YxATG(On.ly on Mail-In Applicafiocas) � 2.00 <br /> 4. TUTAI.P1�:�M1T�'EE(Add Lincs 1-3 Above) $ �a�0��J 0 , <br /> • '" CONTRACT pRICL or rbD COS'�means the actual or eatimated dollar amount charged for the <br /> permitted w�ork including materials,labor,pra�it,and other fixed costs. 1L is the amount to be c��god <br /> . to the customec for tiic.�vork danc. If any mat�erial, equipmcnt, lab�r or installaflo��s are furnishod by <br /> tho owner, tenant or arry othor party, Yhe rcasonAble market value of such items musL•be addad to the <br /> estimated cc��t nr contract price for permit fee purposes. �tt the event that there is a dispute on the <br /> amount of the job cosc,the City may request the�ubmission of a signed �py of the act�ial contreek <br /> '�'hc�uradeKsigned hcrcby appIies lo tt�e Cily for is9u�zce of a Nxeehanical�'ormi�, agecs to do all <br /> � work in strict accordance wiili iFie ardinancrs of tkae City and thc re�lations of the State o£ <br /> � Minnesota, and certifies that all staiements mado on tlus application are complete, true and <br /> correct, <br /> A,nplzcant's SignaUue: .�,�pl.�,/ �GIl��ltiu�xn/vL_ Date: ,_,_, � ���J'�01� ._. <br /> ' 1 i <br /> 3 <br />