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12-12—'16 09:50 FROM— T-559 P0003/0004 F-671 <br /> � . , <br /> pEI�MIT FEE..CALCCJ7,;A,TION(S) <br /> .. .. <br /> �BASED Q�F-2002 STATfi.STA.�`UE. . <br /> [� 'Yes,this section�pplies <br /> Thc replacement of a�tesidenCial fixGuo or apuliance that meers all three af the fplloWing r'r,quirements: <br /> 1. Does not requi�e modifieation to electrical or gas serviee. <br /> 2. Has a total cost of$500.00 or less;cxcl i the cost of the fixture or appliance:and <br /> 3. 1s improvcd,installed or replaced b�+tht homeowner or licensed contractor_ <br /> Skip nexC stction,if this applizs; Cost of Pcrmit $ 15_00 <br /> Statz Surchargc $ 5.00 <br /> Mail-In fiee(If Applicable) $ 2.00 <br /> Total I'ermit Fee $ <br /> PERMIT�EE CALCULATION S �-ra�s ovER ssoo.00 : � <br /> Yf above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE �is 1?5%of contrttct price with a(Minimum�ee of$50.00) <br /> L � /I�I ;j•Q �W���1� ,ri����rh'.: <br /> � ,��� ��� � <br /> 2_ STr#'x�S�lYiCHARGE �a�5.7i� <br /> x: bps:,'� �.`'{''� �.� <br /> 3. POSTAGE&HANDLJI�iG(Only on Msil-in Applicadons) �_� .s��:�:' <br /> 4. TOTAY,p�RMIT FEE(Add Lines 1-3 Above) �:��•9;t° � , u" }'a'`r`'*�`'�1':� <br /> a. ;>3. t�..�.�i..M;'E:• �':•v, <br /> ■ '� CONIRACT PRICL or 70$ COST mtans the actual or estimated dollar amount charged for the <br /> permittcd work including materials,labor,profit,and other fixed eosts. It is the amount to be charg�d <br /> to the customcr for the wo1'k done. If any mattrial,cquipment,labor or installxCions are furnished by <br /> tha owner,tenant or any other party,the reasonable market value of such items must bc added to the <br /> esumated eost or eontracE price for permit fee purpo3es_ In the event that there is a dispute on the <br /> amaunt of the job eost, the City may request the submission of a signed copy of the aetual eontract. <br /> IVIECHAN7CAL�ERMIT APPLICATION'AGREEMENT <br /> The undersigned hereby applies to ih�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 ma on this application are complete, true and <br /> cor�ect. <br /> Applicant's Signature: ���gq;: l�Z������,0 <br /> 3 <br />