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9331869 19:10:20 08-01-2014 4/4 <br /> , . . , <br /> i <br /> PERMIT FEE CALCULATION(S) <br /> ` BASED OFF-2002 STATE STATUE <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or a�pliance that meets aIl three of the following requirements: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$540.40 or less;excludin¢the cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor. <br /> Skip next section,if this applies; Cost of Permit $ 15•00 <br /> State Surcharge $ 5.00 <br /> Mail-Tn Fee(If Applicable) $ 2. 0 <br /> Total Permit Fee $ <br /> PERMTT FEE,CALCULATION S -JOBS bVER$500:00 <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> )`-�>.`" x.0125$ ��.'a� .�1: Z`� <br /> (contract pricc) (minimum 550.00) <br /> 2. STATE SURCHARGE �, <br /> i`�C;li.``— x.OU05 $ /,�`'� <br /> (controct price) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ ��_, `-;� <br /> • * CONTRACI' PRiCE or JOB COST means the actual or estimated dollar amount eharged for the <br /> permitted work including materials,labor,profit,and other 6xed costs. It is the amount to be charged <br /> to the customer for the�vork done. If any material,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 to the <br /> estimated cost or contract price for permit fee purposes. In the event that there is a dispute on the <br /> amount of the job cost,the City may request the submission of a signed copy of the actual contract. <br /> 1v1ECHANTCAU PERIvIIT.APPLICATION A.GREEMENT <br /> The undersigned hereby appiies to the 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 ali statements made on this application are complete, true and <br /> , correct. <br /> �-} �/i%/y <br /> Applicant's Signature: ')���� � � Date: <br /> ,.- . <br /> 3 <br />