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08/18/2004 09:20 FA% 763 591 6071 IVERSON (�009 <br /> PFR�.FEE C T.c�in.e�rrnrrrei �I� SG�,�,S-�,� lr <br /> - - - (�-� <br /> 2002 State Statute [] Yes, This Section Applies <br /> The replacement of a Residential fix �r or ap ' �P that meets all �ree of the following � <br /> requirements: <br /> 1) Does not require modification to electrical or gas servjce. <br /> 2) Has a total cost of$500.00 or less; CXC�the cost of the fixture or appliance: <br /> and . <br /> 3) Is improvcd, installed or replaced by the homeowner or licenced contractor. <br /> Skip next section; Cost of Permit $ __ 15.00 <br /> State Surcharge $ _ ,Sp ! <br /> Mail In Fee • $ 1.50 <br /> If above does not apply, follow guidelines below: <br /> 1: Contract Price* is ,0125 % of job with a �um Fee of ES35 001 <br /> C�C� , w <br /> . x .0125 $, , <br /> (contract price) (miaimum$35.00) <br /> 2. State Surchar¢e. '** Add the State Building Code Division a (Minimwn Fee of$ .30) <br /> - �(�.�Q- ,...i <br /> ��(/ x .0005 $ <br /> (contract price) (minimum$ .SO) <br /> 3� . (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERIVIIT FEE (Add lines 1•3 above) $ <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted <br /> � work including materials�labor,profit�and other fu�ed costs. It is the aanount to be charged to the cu5tomer <br /> f�r the work done. If any material, equipment, labor.or installation are futaished by the owner, tenaat or <br /> any other party the reasonable market value of such items must.be added to the estimated cost or coarract <br /> price for permit fee purposes. In the event that there is a dispute on the amotnt of the job cost.tho Cin•may <br /> request the submiasioa of a signed copy of the actual conttact. <br /> ** T6e STATE SURCHARGE is.0005 of the contract price under$1,000,000 or �.50-whichever is greater. <br /> � For valuations over$1,000,000 call the Department of Inspection Services for the price. . <br /> _ The undersigned hereby applies to the City for issuance of a Plumbing Permit, agrees w do all <br /> work in strict accordance with the ordinances of the City and the rGgtilations of the State of <br /> Minnesota, and certifies that all statements made on this application are complete, true and <br /> correct. <br /> Applicant's Signa .��..p c� • <br /> Date: <br />