2017-01117 - mechanical - Laserfiche WebLink

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09/ 2/2017 12:48 7635354379 GOLDEN VALLEY HTG PAGE 03/04 • 1•F�t�s �"titF ^ Py., � ,�5�' .�y-N� rl io , 41 �'t"}�'+'�F*-,-ao'+r- f r�. . X(. 1 r r .J... .6z i�t .�"4l a.r YL?,a . � a 3 � w 3br ,f.. El Yes,this section applies The replacement of a R idential fixture or ap Bance that meets all three of the following requirements: 1. DQes not require modification to electrical or gas service. 2_ Has a total cost of$500.00 or less;exciu n the cost of the fixture or appliance:and 3. Is improved,installed or replaced by the homeowner or licensed contractor. Skip next section,if this applies; Cost of Permit $_ 15.0Q State Surcharge $ 1_00 Mail-In Fee(If Applicable) $ 2 00 Total Permit Fee $ �. '�.,->F.,`ti ,Fc"`�t�y"'j^y".�r,�r ' "�`-- "..^z ^-••n om-n...., wz a9 •e If above does not apply;follow guidelines below: L CO1V'TRA 'I'P CE *is 1.25%of contract price with a(Minimum Fee of$50.00) x.0125$ (contract price) (minimi $0.00) 2. STATE SUR HARG.E (4 , Sax_0005 $ (contract price) S. POSTAGE&HANDLING(Only on Mail-In Applications) $ ZOO I4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ i * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged far the permitted work including materials,labor,profit,and other fixed costs_ It is the amount to be charged to the customer for the work done. If any material, equipment,labor or installations are furnished by the owner,tenant or any other party, the reasonable market value of such items must be added to the estimated cost or contract price for permit fee purposes. In the event that there is a dispute on the amount of the job cost,the City may request the submission of a signed copy of the actual contract. I�V�'`�ti3;ir�'ix,f�� Tre.. .. ''�.�y.r"jtz�'"'lM, to T.� t'✓Pa"_"'"""�z' _;'c--^ The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all work in strict accordance with the ordinances of the City and the regulations of the State of Minnesota, and certifies that all statements made on this application are complete, true and correct. Applicant's Signature: 5, l a! f es. Date: 17' 3