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If - _ _ _ __ __ _ ___ _. -- <br /> PER'�IIT FEE Ct�LCUL_�TTON(S) <br /> ', B�SED OFF - 200? STATE STr1TUE <br /> ❑ 1"es,ttvs section applies <br /> "Ihe re lacement ofaRes�de��alfitture or appliance that tt�eets alltt�ree oftl�e foll��vu�g requgertYnts: <br /> P _,. , e . ..._ , _ <br /> 1. Does mt requu�e imdifuation to electricalor gas service. <br /> ?. Has a totalcost of�500.00 or less;e�chxiu�g tl�cost ofthe fiKtt�re�appliatxe:arul <br /> 3. Is ur�roved.iristal�ed or replaced by tl�hoineo��me�-or licensed contractor. <br /> Skip ne.�t section ifttvs applies; Cost ofPemvi �.� 15__�___00 <br /> State Simcharge ��_ 5.00 <br /> :��Iai�InFee(IfAppiicable) $ 3�00 <br /> Total Peinut Fee S <br /> . . . ___..._._------. --- -._________ _.._.._.____._.__,.._.._._. ._.__ <br /> C__._.__�_______�.___,..P�IT FEE CALCULATION(S)-JOBS OVER$500.00 <br /> Ifabo�e does not apply;follow guidelines belo�v: <br /> 1. COI�TTRt1CT PRICE *is 1.25?�0 ofconiract price with a(113inimum Fee of S50.00) <br /> ����� Y.01255 <br /> (contrnct prie) (mininum^�50.00) <br /> 2. STATE SLiRCHARGE <br /> x.0(105 � <br /> (c�tract pri e) <br /> 3. POSTAGE�C:HANDLING(Only on Ma�In Applications) �____...._ePONT2�00 <br /> 4. TOTAL PERMIT FEE(Add Lnyes 1-3 Above) S <br /> - � CONTRACT PRICE or JOB COST urazls die actual or estnnated dollar aimucu cl�arged for tk�e <br /> penrritted work inchadi�g ir�ateriaL, labor,profit,and odier fiied costs. It is die aimwvt to be charged <br /> to tl� customer for tt�wodc dor�e. Ifairy material equipinent, labor or irvtallations are fimusl�ed by <br /> die owr�er, tenant or any other party, the reasonable iY�rket��ahae �f such itena tYnast be added to the <br /> estn�ted cost or corixract price for percYrit fee purposes. In tlre e��ent that there is a dispute on the <br /> auriurt of the job cost, the Ciry rYny request the st�tr�sion of a signad copy of the actual contract. <br /> MECHANICAL PERMiT APPLICATTON AGREEMENT <br /> Tt�tnidersi.gtied hereby applies to ttie City for issi�ance of a 141echatucal Pznmt, a��e�ta dca aIl <br /> wot�C in sh-ict accordance �e�h tt� ordinances of tl� City and t�� re�.ilatior� of the Statz of <br /> Mi�mesota, and ceitifies that aIl statements made on thi� appl�ation are carrq�lete. ti1�e and <br /> con�ect. <br /> App�icanYs Signature: � Date: �� � d���3 <br /> 3 <br />