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9529331869 00:08:11 06-20-2014 4/4 <br /> ` ; PERMIT FEE CALCULATiON(S) , <br /> BASED OPF;=2002 STATE STATUE <br /> ❑ Yes,ihis section applies <br /> The replAcement of a Residential fixture or appliance th�t meets all diree of the followin�requirements: <br /> 1. Does not require modifieation to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excludina tl�e cost of Uie fixture or appliAnce:and <br /> 3. Is improved,installed or replaced by tl�e homeowner or licensed contt�actor. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Surcl�nrge $ 5.00 <br /> Mail-In Fee(If Applicable) � 2.00 <br /> Total Permit Fee $ <br /> PERMIT:FEE GALCULATIbN S)-JOBS OUER;�540.00 <br /> If above does uot apply;follow guidelines below: <br /> 1. CONTRACT PRICE *is 1.25%of contruct price witl�a(Minimum Fee of$50.00) <br /> -� �— , ��- <br /> �.`� UG x.0125$ �C� � 6� <br /> (co tract pricc) (minimum SS0.00) <br /> 2. STATE SURCHARGE � <br /> x.0005 $ /� 7� <br /> (contrrcl price) <br /> 3. POSTAGG&I-IANI�LTNG(Only on Mail-In Applications) � 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines !-3 Above) � �J� 7 J <br /> • • CONTRAC'C PI2ICE or JOB COST means il.ie actuA) or estimated dollar amount charged for tlie <br /> pennitted work including t�i�teri�is,labor,profit,and other fixed costs. It is tl�e amount to be charged <br /> to the custonier 1'or the work done. Tf�ny material,equipment, labor or instnliations are lurnished by <br /> Uze owner, te��ant or any other paRy,the re�sonable market v�lue of such items must be added fo Uie <br /> estimated cost or contract price for pennit fee purposes. In the eve�u that there is a dispute on the <br /> amount af d�e job cost,the City may request the subniission of a signed copy of Uie actual contract. <br /> 1vIECHANTCAL;PERIvIIT APPLTCATION AGREEMENT <br /> The undcrsigned hereby applies to the City for issuance of a Mecl3anical 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 scatements made on this application are complete, We and <br /> correct. <br /> � , ,/ <br /> Appiicant's Signature: ���` ��%��-��` '��G` l"Date:� � /7 <br /> , <br /> 3 <br />