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4 ' <br /> � PERMIT FEE CALCULATI�N{S} <br /> BASED OFF- 20(l2 STATE STATUE <br /> ❑ Yes, this section applies <br /> The replacement of a ResidenCial fixture or appliance that meets all three of the following requireinents: <br /> L Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excludine the cost of the fixture or anpliance: and <br /> 3. Is improved,installed or replaced hy the homeowner or licensed contractor. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-[n Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> �� . � . . . ��`:�`���i�`"'4.r�����`�.�Qi`f ��.���^-���QS7«.�����.AJ��.� �,;.� . � .. . <br /> If abovc docs not apply;follow guidelines below: <br /> L CONTRACT PRICE 'k is 1.25°Jo of contract pricc with a(Minimwn Fee of$50.00) <br /> �Ob� � .0�25 � ��. <br /> �contract price) (minimum�;50.00) <br /> 2. STA1'E SURCHARUE <br /> �o � .���5 � 3�� <br /> (contract pricc) <br /> 3. POSTAGE& HANDLWG(Only on Mail-In Applications) $ 2.00 <br /> �i. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ �"1�"�.�� <br /> • ' CONTRACT PRICE or JOB COST means thc actual or estimated doilar amount charged for the <br /> permitted work including materials, labor, profit, and other fixed costs. lt is ihe amount to be charged <br /> to lhe customer for thc work done. If any mat�rial, 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 co fhe <br /> estimated cosC or contract price for permiC fee purposes. In the evcnt that there is a dispule on the <br /> amounY of thc job cost, the City may reyuest the submission of a signed copy of the actual contract. <br /> MECHANICAL PERMIT APPLICATION AGRBEIviENT <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all <br /> work in strict accordance with Che ordinances of the City and the regulations of the State of <br /> Minnes��ta, ancl certifies that all statements macle on this application are complete, true ancl <br /> correct. <br /> Applicant's Signature: ��yV•`�' Date: C��—"'�_1 �_----- <br /> R�34�t FtN'E�i <br /> 3 <br />