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i <br /> PERMIT F'1✓VCALEULAT N(S) <br /> r <br /> ® Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requirements: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excluding 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 $ .50 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> FERMT <br /> FEE,� I CUI 1�`�'��1��5�-JQ�3�C)��R$5£16.00 " <br /> If above does not apply-,follow guidelines below: <br /> 1. CONTRACT PRICE *is 1.25%of contract price 'th a(Minimum Fee $ 0.00) <br /> y <br /> x.0125$ <br /> (contr ct price) (minimum$50.00 <br /> 2. STATE SURCHARGE **Add the State Bldg Code Div. Surcharge(Minimum Fee oV$ ) <br /> y x.0005 $ / <br /> (contract price) (minimum$ .50) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ <br /> 4. TOTAL PERMIT FEE Add Lines 1-3 Above $ <br /> ■ * CONTRACT PRICE or JOB COST means the actual or estimated dollar or the <br /> permitted work including materials,labor,profit,and other fixed costs. It is the amount to be charged <br /> to the customer for the work done. If any material,equipment, labor or installations are famished 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 /> ■ **The STATE SURCHARGE is.0005 of the Building Department at(952)249-4600 for the price. <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all <br /> work in strict accordance with the ordinance f the City and the regulations of the State of <br /> Minnesota, and certifies that all state e n this application are complete, true and <br /> correct. ■ <br /> Applicant's Signature: Date: yC <br /> 3 <br />