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• ' 10-24—'17 10:04 FROM— T-996 P4003/0004 F-374 <br /> � 'PERMIT FEE CALCULt1T10N(S);: <br /> �BASED.OFR.�='2Q02.ST.A,'�'��STATCI�.. � <br /> ❑ Yes,this section applies <br /> The replaeement of a Rzsidantial�xture or appliance that mcots all threc afthe following reyuircr�tents: <br /> 1. Dc�es not require madificatian to electricsl or g8s serviee. <br /> 2. Has a total cost of$500.00 ar less;�xcludin�the eost of the fixture or appliance�and <br /> 3. Is impro�ved,installed or replaeed by the homeowner or licensed contractor. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mai!-In Fcc(If Applicable) $ 2.00 <br /> Total Permit Fee $� <br /> pB�tM.YT.�EE.CAY�,CLTL-ATION S)=J0$S.OVER.$SOO.QU:..:� . : . : ..:' . : <br /> Yf above does not apply;follow guidelincs below: <br /> 1. CONCRACT PRICE 'is l.25%of eontract price with a(Minimum Fee of$50 OU) <br /> ��,5.5 ��WM��.�;9�`�:�;.�.. <br /> (�o3�zs�-,��,,y..�.�s.,,�r�w�-.::r:,,:=;�`� <br /> �a.,. .,� ,;.:...m���: <br /> 2. STAT�sTJ�C�CARCE � 155 $g <br /> x�o0.o� � - <br /> ��'��� <br /> ,,.�..�. <br /> 3. POSTAGE&HANDLING(Only on Mail-Yn Applications) �$ �i':'+:'�:::':�:,::'� <br /> �(�!.,�/�. S� <br /> 4. T07AY.p�RMYT�'�E(Add Lines 1-3 Above) "`' ''"�';'.'�`'`��� •�: <br /> y���"+�� :::i.'r;�%!�y�:i�7�.!..�tl:� <br /> ■ * CON'I'�tt1.CZ' PRCC� or JOB COST means the actual or estimated dollar amount charged for the <br /> permitted work includin.g materials,labor,profit,and ather fixtd eosts. It is the amount to be charged <br /> to tlle customer for the work done_ If any materia4,equipment,labor or installations are furc�ished by <br /> the owner,tenant or any other parry,the reasonable market value of such items must he added to the <br /> estimated cost or contract priet for petmit fee purposes. Yn the event that there is a dispute on the <br /> amount of the job cost,the City may requast the submission of a signed copy of tho actual contract. <br /> ,1V�.SGT�AI�TICAr,PBRMYT�APPLICATION ACrREBMBI�'T. . .. . <br /> The under3ig,ned hereby applies to the City for issuance of a Mechanical l'ermit,agrees to do all <br /> work in sti-ict accordance with the ordinances of the City and the regulations af the State of <br /> Minnesota, and certifies that al! statements made pn this application are complete, true and <br /> correct. <br /> A licant s Si nature: fe:' �O ���(� <br /> PP '' g ��� <br /> 3 <br />