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,, MAY/�4/2013/FRI 08:44 AM FLAAE HEATING FAX No, 7635423101 P. 003 , � . � Yes,Chis sectioa applies The replacement of a Residential fixture or appliance that meets all tbree of the following requi�rements: 1. Does nat require mod'�ication to electrical or gas service. 2. Has a total cost of$500,00 or less;excludin¢the coat of the frxture or appliance:and 3. Is improved,iwstalled ox cepl,aced by the homeowne�or licensed contractor. Skip next section,if this applies; Cost of Permit $ 15.00 State Surcharge $ S.QO Mail-In�ee(J,£,A,pplicable) $ 2.00 �'otal�'ermit Fee S If above does not apply;follow guidelines below; 1. CONTR.ACT pRTC�+ x is 1,25%of contract prica with a(A3inrmum T�'ee of$50.00) �7�1�r� x.0125$ � C�� • �� (contcact price) pniuimuea$50.00) 2. STATE SYJ�.tC�tG� C�� L�'�� x.0005 $ �C� • Z-.� , (contract price) 3. POSTAGE Bc HAND'LWG(Only on Mail-Tn Applica�ons) $ 2.00 4. TOTA�.��T FE�(,A,dd L,iwes �-3 Above) S I Q—l� - �1 � , ■ '� CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted work including matemials,labor,profit,and other fixed costs. It is the amount to be charged to the customcr for the work donc. lf any mattrial,equipment,labor or insCallations srt fiunishcd by che owner,tenant or any other parry,the reasonable market value of such items must be added to the estimated eost or contract price for permit fee purposes: In the event that there is a dispute on the amount of the job cost, We City�nay request the submission of a signed copy o�the actua� contract, The u.ndersigned hereby applies to the City for issuance of a Mechanical Permit, agrecs 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: Date� � Z � 3