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02/20/2018 14:39 7635354379 GOLDEN VALLEY HTG PAGE 03/04 <br /> f u�z� rY t r •J'r k;�� <br /> r ti K w Si f. <br /> Yes,this section applies <br /> The replacement of a Residential fixture or apgance that meets all three of the following requirements: <br /> L Does noii require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less; gthe cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor. <br /> Skip next section,if this <br /> applies; Cost of Permit $ 15.OQ <br /> { State Surcharge S <br /> Mail-In Fee Cif Applicable) $ 2.00 <br /> Total Permit Fee <br /> { <br /> If above does not apply;follow guidelines blow: <br /> I ' <br /> 1. CONTRACT PRICE *is L25%of contract price with a(Minimmn Fee f$50.00) <br /> X000. - <br /> x.0125$ U�� <br /> (comet price) (minim m 550-00) <br /> 2_ STATE SORCHARGF Ir <br /> 00 0x_0005 $ O <br /> (contract price) <br /> 3. POSTAGE&IHANDLIIsTG(only on Mail-In Applications) <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ <br /> \1 . <br /> " CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the <br /> permitted work including materials,labor,profit,and other fixed costs. It is the amount to be charged <br /> to the customer for the work done. If any material,equipment,labor or installations are furnished by <br /> the owner,tenant or any other party,the reasonable market value of such items must be added to the <br /> estimated cost or contract price for permit fee purposes. In the event that there is a dispute on the <br /> amount of the job cost,the City may request the submission of a signed copy of the actual contract. <br /> I � <br /> - <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all <br /> l i work in strict accordance with the ordinances of the City and the regulations of the State of <br /> • Minnesota, and certifies that all statements made on this application are complete, true and <br /> correct. <br /> Applicant's Signature: ��j,L1 ' Date: • d ' • )5 <br /> i � I <br /> 3 <br />