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From:COUNTRYSIDE HEATING & COOLING 763 479 2518 02l24l2015 12:30 #021 P.003/003
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<br /> ❑ Yes,this section applies
<br /> The replacement of a Residential fixture or apnliance that meets all three of the following requirements:
<br /> 1. Does not require modification to electrical or gas service.
<br /> 2. Has a total cost of$500.00 or less;e�luding the 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 applies; Cost of Permit $ 15.00
<br /> State Surcharge $ 5.00
<br /> Mail-In Fee(If Applicable) $ 2,pp
<br /> Total Permit Fee $
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<br /> If above does not apply;follow guidelines below:
<br /> l. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00)
<br /> �(�� x.Ol 25$ �`7�
<br /> (contract price) (minimam�SS0.00)
<br /> 2. STATEStJRCHARCE r ,zQO
<br /> x.0005 $ �_ (p
<br /> (contract price) '
<br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ —2:U6--'
<br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ �L��_ �j�
<br /> • * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount chazged 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. lf any material,equipment, labor or installations are fumished by
<br /> the owner,teaant 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 actuai contract.
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<br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all
<br /> 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.
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<br /> ApplicanYs Signature: '��,,�'G �'.�' Date: o( 'e��-��
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