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07-01-02 10 : 02 GOULET HOMES INC ID=612 253 6161 P . 04 <br /> u I-neo f ILIUMWO 1-1151 <br /> • I <br /> pE CALCULATThN(S) <br /> 2002 S , to State El Yes This Section tu <br /> The replacement of a esid Kitt ixnirapplipp�ance that meets all three of the following regtlirextents: <br /> 1) atm=require modification to electrical or gas service. <br /> 2) I las a tura t of$500.00 or less;excluding the cost of the fixture or applies <br /> and <br /> 3) Is improved, installed or replaced by the homeowner or licensed contractor. <br /> Skip next section; Cost of Permit $, <br /> State Surcharge$ P <br /> Mail-In Fee $ <br /> If above does not apply,follow guidelines below: <br /> 1. Contract Price*is.0125%of job with altigimangiggl <br /> 620 4.0 C x.0125 $ 7r 0 <br /> (contract price) (minirAw►$35.00) <br /> 2.S1m,„§ rchharac. **Add the State Building Cade Division aMinimum 'ee ofJ SO) <br /> �zOc9 t�r� x.0005 $ 3 / D <br /> (contract price) (mitirstum$,50) <br /> 3, Poostage�$fid A�t> ng(Only mail-in applications) <br /> 4.TOTAL PERMT FEE(Add.lines 1-3 above) $ 0 <br /> *CONTRACT PRICE or JOB COST mean the aortal or estimated dollar amount charged for the permitted work'including <br /> materials,labor,profit,and other Fixed costs.It is the amount to be charged to the customer for the work done:l' y material, <br /> equipment,labor,or installation is furnished by the owner,tenant or any other parry the reasonable market value: (such items <br /> must be added to the estimated cwt or contract pi ice for permit fee purposes.In the event that there is a dispute,cul the amount of <br /> the job cost,the City may request the suhrniviion of a signed i copy of the actual contract. <br /> "The STATE SURCHARGE is.0005 of the contract price under$1,000,000 or 5,50-whichever is greater.Fpr*eluations over <br /> 51,000,000 call the Department of Inspectional Services for tete price. <br /> The undcrs;sued hereby applies to the City for issuance aft Mechanical Permit,agrees to do all work in strict accordance with <br /> rho ordinances of the City and the regulations of the Minnesota State Building Code,and certifies that ail statements made on MIS <br /> application arc complete,true and correct, <br /> Applicant's Signature: A / !, Date <br /> Approved By: .�.,. Date: <br /> ' 3 <br /> { <br /> 't <br /> kt <br />