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01-16-'18 12:29 FROM- T-416 P0006/0010 F-838 <br /> .• . . <br /> 1?E�tiv���'FEB CALCUL;ATION($) . <br /> �4S�0 0��.-2002�STATE.STATUE ... . <br /> ❑ Ycs,this section applics <br /> The repl&cement of a Residential fixturc ar appliancc that meets all Ehree of the follpwing requirements: <br /> 1. boes not require modification to electrical or gas sorvice. <br /> �. Has a total cost o�f$500.00 or less;eXCllldin the cost of the fixture or appliance:and <br /> 3. Ts improved,inscalled or replaced by the homeowner or licensed contractor. <br /> Skip next section,if this applies; Cost of Yzntlit $ 15.00 <br /> State Surcharge $ S..QO. <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total permit�'ee $ <br /> , .. ... <br /> ���X'Z'�'EE.CAI;CUL?,TION(S)�JOBS O�'ER$500.00 <br /> If above does not appiy;follow guidelines below: <br /> 1. CQiV'Y'YtACT PRYC� °is 1:?5%of contrac�rice with s(lhlinitnum Fee of$50.00) <br /> •' y''s;q�;''�':���f i ���,�r;.<; <br /> �,C:w�'',�;.,'!i. �D' .,i, <br /> � �PIO ..... <br /> 2. STATE SURCHARGE ^ A �� <br /> ��O °/�.,•�vtf. <br /> �X YQ.V�:i��D� � <br /> � <br /> 3. pOSTAG�&�TA1VriLTNG(Only on Mail-Tn Applications) $ ���i`,^^ <br /> f 5 <br /> 4. TOI'AL PERiVIIT F��(Add Lines 1-3 Above) e��"�`�.�.��.� <br /> ■ ° CONTRACT PRiCE or JOB COST moans tlie actual or estimated doUar amount charged for the <br /> permitted�vork ineluding matcrials,labor,profit,and othcr fixed costs- It is tha amount to be charged <br /> to the customer for thc r�+ork done. Tf any materiRl, equipmtnt,labor or installations are furnishcd by <br /> thz owner,tenant or any other party,the reasonable market value of such items must bc added to the <br /> estimated cost or contract price for permit fez purposes. Tn the event that thtrc is a dispute o�� the <br /> amount of the job cost, che City may request thz submission of a signed copy of the actuAl contract. <br /> MECHAI�TICAL EERMIT APPLICATION:AGT�EMENT'... .. . <br /> The undersigned hereb�applies to the City for issuance of a Mechanical Permit,�grees to do all <br /> work in stiict accordance with the ordinanees of the City and the regulaiions of the State of <br /> Minnesota, and cenifies that atl statements made on is application are complete, true and <br /> correct. <br /> ApplicanYs Signature: ` D�e''� I r ( (..�!J D <br /> 3 <br />