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1UN/21/2016/TUE 09; 39 AM Heating & Cooling 2 FAX No, 7634283677 P, 004 <br /> ., �7�7� ��+!�y��''/"1.:]� � � h� .� r�Q'�f.; e n_. rYr .� ". r � . �. <br /> t� . ' >> > ���i...Y Y�{.v�'1 . [ � �lA� ����� r ' � <br /> �{� �_�j�� 4! �:j a�.�•1 �r'�y �V;��I�����\ �.S*iY��t�.V„:�a���� �.�+"�ii �X � }'� � �f ' Y.�, <br /> ❑ Yes,this section applies <br /> 1"be replacement of a Resi�icn,�' ��,x�r or appliance that meets all thrc�of the following requ�rernenis� <br /> 1. boes not require modification to electrical nr gas service. <br /> 2. Iiss a total cost of$500.00 or less;excludinQ the cost ofL�o fixnay'e or appliance: and <br /> 3. Is unproved,inst�lYcd ar rpplaced by the homeowner or licensed contractor. <br /> C'L:.,.,nvt oP6�0&����.e e�p^p^��:o� C4$T Q�P•TSY11f +fa-75 Q� <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Perxuit F�e $ <br /> % �:•N. .�+'.i-'i`-`•1`:`�� �. .�f.,.� /���.! � �f .�� ..�:, ��'��' '`�tl'9.,'1`�' ��`.r��; <br /> ! <br /> i�'aUove does not apply;follow gu.idelines below: <br /> 1. CCINTRACT��dYCE *is 1.25%of con�xct price with a(1V�inimum Fee oi'�50.00) <br /> o� <br /> " 1 dU � �.oi2s$ <br /> (c niract pncc) (yn➢hitnum$90.00) <br /> 2. STATE SCT�tCHAYtCE � �l� <br /> x.0005 $_ <br /> ( tract pricc) <br /> 3. POSTAGE&HANDLTN"G(Only on Mail�in Applications) $ 2.00 <br /> 4. TOTA�,P�RMTT k'EE(Add Lines 1�3 Above) � ��' '`�� <br /> ■ * CONTRACT PRrC� or 70$ COST means the actual or estizraatac� dollar arriount chargcfl £or xhe <br /> permitted work inciudaug mate�lals, labpr,profit,and other flxed costs. Tt is the amount to be eharged <br /> to the customer for tlie work done. Tfi any yrsaterial, equipment, labor or installations are furnished b� <br /> the owner, tenant or a�xy other parry, the reasonable ma.r�value of such ite�.s rnust be added to the <br /> estima.ted cosC or contraat price for permit fee purposes, Tn the event that thexe xs a dispute on the <br /> azuount of the job cost, the CiTy may request t1�e submission of a si�ned copy of the actual conUract. <br /> �.f �.G 'q�(� 4 77�„y�7� . {� �` <br /> . �'.�15 ��.�'.��S �'��.,lY1Li���L�.J.[�.M>.��..�� � ;e..�' �i �..1.�..'t���,...�Tf��'?�.'..` �s.1�•�� �4�,,i�e�� 1 r �F� <br /> J <br /> '�'he undersigned hereb� a�plies to the City for issuance o�'a Mechanical Potmit, �tgrees to do all <br /> work zn strict accordauee with tlle ordinazioes af the City and the reguletions of the 5tate of <br /> Minnesota, and co;rti�es that a11 statem ts m au this application are complete, true and <br /> correct. <br /> Applicant's Sign�ture: bate: 7i <br /> , 3 <br />