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, . . <br /> PERMIT FE�CA�C[�A�t?�T{�}" < <br /> BASED OFF-2t1�}2 STA"T'E S"�,�"�"'�3'E. <br /> ❑ Yes,this section applies <br /> 'The replacement of a Residential fi�cture or apoliance that meets all three of the following requirements: <br /> 1. Dces not require modification to electrical or gas service. <br /> 2. Has a tat�of$500.00 or less;excludin¢the cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor. <br /> Skip neact section,if this applies; Cost of Permit $ 15.00 <br /> State Surchazge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> FERIvIIT 1�EE CALCUi,A'FT4N 5 -3�BS OVET�$5�.4U <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE *is 1.25%of conlract price with a(Minimum Fee of$50.00) <br /> y��• �� x.0125$ ,.7 d•� <br /> (contract price) (minimum 550.00) <br /> 2. STATE SURCHARGE <br /> Y�, c.�v X.000s $ 2. �v <br /> (contract price) <br /> 3. POSTAGE&HANDLING(Only on Mait-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ $�� <br /> ■ • CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the <br /> permitted work inciuding maxeria(s,;lab�r,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 otlier 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 /> 1�CHA,N�CA�.PE;RM��'.�'�LT��4`I�f��T t�CiREEIU�ENT r <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. <br /> Applicant's Signature: � 1!-� Date: `7 / <br /> it�t f� <br /> 3 <br />