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A��' ' <br /> p��r��c�.e��or��s� . <br /> BASED QFF-200�STAfiE�'I'ATUE . <br /> ❑ Yes,this section applies <br /> T'he replacement of a Residential fixture or appliance that meets all three of the following requirements: <br /> 1. not require modification to electrical or gas service. <br /> 2. Has a cost of$500.00 or less; ceac ludina the cost of the fixtu�e 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 Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee S <br /> PE�viIT FEE CALCt1I+AT�Q1�T S ,--JQBS fl�ER 5500.(�3 <br /> If above dces not apply;follow guidelines below: <br /> 1. CONTRACT PRICE •is 1.25%of contract price with a(Minimam Fee of$50.00) <br /> ���' �� x.0125 S vc>.vt,9 <br /> (contract price) (minimam SS0.0 ) <br /> 2. STATE SURCHARGE <br /> x.0005 $ S�•� <br /> (contract price) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) S ���- � <br /> • * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the <br /> permitted work including materials,labor,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 other 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 tLe actual contract. <br /> I1+IEGH�t�lIG�4�.;�'�RA+II'I't�PFLICA�fD1++T.�CyREEhI�T <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: Date: �j � � <br /> '��8�#�0�3�'t <br /> 3 <br />