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08/1'/2004 09:21 FA% 763 591 6071 IVERSON f�O10 <br /> J � ' . - <br /> r � <br /> RFjZMiT FEF Ca�CI1T.ATION(Sl "'� � �k%v�ST�"� �t'e <br /> 2002 State Statute [] Yes, This Section Applies � <br /> The replacement of a Residential f xture or �,� �anc _ that meets all three of the following . . <br /> requirements: . <br /> 1) Does not require modification to electrical or gas service. <br /> 2) Has a o c s of$500.00 Qr less; c d' the cost of the fixture or appliance: <br /> and � <br /> . 3) Is improved, installed or replaced by the homeowner or licenced contractor. <br /> Skip next section; Cost of Permit $ __ 15.00 <br /> � State S�rchazge $ .50 <br /> Mail In Pee � S 1.50 <br /> .If above does not apply, follow guidelines below; <br /> 1, Contr�t Price'" is .0125 °!o of job with a Nlinim�un Fee of(t35 001 <br /> . �oU� . w x .0125 $. . <br /> (contract price) (minimum$35.00) <br /> 2. State SurcharQe. ** Add the State Building Code Division a (Minimum Fee of$ .50) <br /> . �� <br /> . 0. x .0005 $ <br /> (contcact price) (mini.mum$ .SO) <br /> 3. . �ostage and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ <br /> '" CONTR.ACT PRICE or JOB C05T means the actual or estimated dollaz amount charged for the permitted <br /> � work including materials,labor�profit,and othec fi�ced costs. It is the amount to be charged co the cusrnmer <br /> for the work done. If any material,equipment, labor,or installation are furnished by the owner, teaant or <br /> aay other patty the reasonable tnarket value of such itema must.be added to the estimated cost or cootract <br /> price for permit fee pucposes. In the event that there is a dispute on the amount of the job cost, the Cin-may <br /> request the submission of a signed copy of the actual contract. <br /> ** T'ho STATE SURCHARGE is .0005 of the contract price under$1.000,000 or 5.50-whichever is greater. <br /> � For valuations over$1,000,000 eall the Department of taspectioa Services for the price. . <br /> The undersigned hereby applies to the City for issuance of a Plumbing Perm.it., agrees to do all <br /> work in strict accordance with the ordinances of the City and the reguladons of the State of <br /> Minnesota, and certifies that all st ements made oa this application are complete, true and <br /> correct. <br /> , . . <br /> Applicant's Signa Date: ���''0'� <br />