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. <br /> PERMf"['FEr CALCULATION(S) <br /> . <br /> _____BASEU UFF - 2002 STnTE S'T'A'I'11E <br /> ❑ Ycs,ihis scction a����lics <br /> 'f�hc rcplacement of a Residential fixture or appliancc U�at mcets all Ihree of the iollowing requirements: <br /> I. Uocs not rcquirc modificaticm to electrical or gas scrvicc. <br /> 2. I las a total cost of$500.00 or Icss;excludint�tiic cosi of thc lixlurc or appliancc: and <br /> 3. Is itnproved, insfalled cir replaced by the hcimcciwner or licenscd contractor. <br /> Skip ncxt sccfic�n, if ihis applics; Cost of Pcrmii $ 15.00 <br /> State Surch�irgc $ 5.00 <br /> Mail-ln F'ec(If Applicable) $ 2,pp <br /> 'I'otal Permit Pce ,q', <br /> __ PERMIT FEE CALCULATION(S)-JOBS OVER $500.00 <br /> ff ahovc docs not ap��ly; fallow guidelincs helow: <br /> I. CON7'RAC'I' PIi10E * is 1.25%of con(ract price wifh �(Minimum I�ee of$50.00) <br /> . S � <br /> s�r-�.5 �� � .oizs � ---t_o °t <br /> _ ___ _ <br /> (conUacl��ricc) (miuimum$50.00) <br /> 2. s�t�nTr sti�tct�nrzcr , y 3$ <br /> $Z E�S �� x .0005 $ <br /> _ __ - _ <br /> -- <br /> (c�mlricl�tticc) <br /> 3. POS"I'n(�F,&c I InNf�L1NG(Only on Mail-In �pplicltions) $ 2.00 <br /> 4. 'I'O'1'AL PF,RMI'I'I�I�,I?(Add I,incs I-i nbovc) ,y; �( cj . �� <br /> • * C�)N"I'RAC"I' P(tl('F? or .IOB ('OS"I' mcans (hc actual rn• cstimatcd dollar amotmt chargcd fc�r the <br /> permiltcd worl< including malcri�ls, labor, ��rolit, and oihcr fixcd cos(s. It is Ihc amount to bc chaiged <br /> ta thc customcr for thc wc,rk d�na If any matcrial, cquipmcnl, lahor or installations are furnishcd hy <br /> thc c�wncr, tcnant or any olher pariy, thc reasonable markel valuc of such itcros musl be added to the <br /> estimafed cost or conh•act ��rice (or permit fee pur��oses. In the event that there is a disputc on the <br /> �mcwnl �f thc job cc�sl, thc ('ity may rcqucst thc submission of a signed copy of thc actual crnitract. <br /> MECHAN(�AL PERMIT APPLiCA'1"ION A'GRE�M�NT <br /> "I'he �mda�signed hcreby applics to lhc City (or issuance of a Mechanical Pcrmit, agrecs to do all <br /> work in strict accordance with the ordinances of the City and (hc regulations ot� the State of <br /> Minncsota, and ccrtifics th� all statci��cnts i adc on tl�is application arc complctc, truc and <br /> corrcct. <br /> npplican('s Signaturc: _ Datc: �__�(�—__ 1g_ <br /> 3 <br />