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. . <br /> F�ER:�T FF.E CA�.CU�.AT10N(Sl . <br /> ?OOZ State Statute ❑ Yes Tbia Sectioa.�►pr.,lies <br /> The replacement of a Residential fiature or apj�fiance tha�mec�s al1 three of tha following requirements: <br /> 1) s n t r�quire modification to electri:al or g�s scrvicc. <br /> 2) �Ias a tot�i cost of�504,00 ar less;e 'n the cost.of the fixture or apptiance: <br /> and <br /> 3) Is improved, ins'23lled or replaced l�y the homeownec or licensed contractor. <br /> �Skip next secuon; Cosi of Permit $ 15.00 <br /> Sc�ce Surcharge$ SO <br /> �4ail•]n Fee $_ 1.50 <br /> lt above does not appty�fultow�guidalincs belaw: <br /> 1. Contract Pric�* is .0125%of jub wich a N1in;mum Fee of(535.001 <br /> �1 .dZ� X .o i�s $ ,�S cSZ� <br /> IeonusM price) (minimum 535.00) <br /> ` Siato Surcha�ee. "'" Add the State Building�n�le I7ivision a Minimum�et of lS .SOI <br /> _/��x.0005 $ •�� <br /> (cantract pricc) (min�mum S.SG) <br /> � Posta�e and Haadling(Only nrail-in pppllcAtiuns) $ ;,5� <br /> 4 TOTAL PERMIT FLE(Add lines 1-3 abcvc) $ 3 �. a� <br /> •CONTR4CT PRICE a JOB CG5T mcans�t�t actuul or esei:natcd dollar amuunt ct�arEed for the pern:ittcd work inefuding <br /> a:atcrial�,labor,prof G an]oth�r fistd co�ts.It u t;+z nmount co tx chargad to the cu�t�mcr for th=work donc.If:�ny marcrial, <br /> �quiprnent,labor,or instnliation i�furnish�by the owne:,ter,ant or any other party the re+�oaab:Z mtu�kZt�nluc of such iteris <br /> rnust be addui to rhe es:icr.ated cos�or con�en price far�rni�i:ee purposcs In the evenc tha�Thcrt is a dispute on�he amounc of <br /> th�•jon cost,the Ciry ma}�requcst thc submission of�s�b�ne��opy oitAe aecual ountract, <br /> '•Tht STATE SURCH.#RGE is.4Q05 of the contract pr;ct under S1,000,000 or 5.30-whic`�cvcr is gtr.a[er.For valuat�un�ovar <br /> 5:,000,09�coll the D�parcrnenc of Jnspectl�nal Services ior tt.c pricx. <br /> Tht undarsignei�hereby a�plizs to the Ciry for issuenec of a:�:e:hanic�l Permit,aYrccs co do all werk in sttict accordaace�i�h <br /> ehc ordinanccs of thc Ciry and the rcgut:uions of the Minnrsoia Stair Buildlr.g Code,and cenlfles that al!stacementa made on chis <br /> applicacon ara complctc,truc an�corteet. <br /> , ����� ;.?' � /�? <br /> �pplicant s Signature:_^__ —_--- �— -- Date: 7" .JQ�a <br /> ,�pproved 8y. Date: <br /> 3 <br />