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9529331869 15 34 12 10 13 2015 4!4 <br /> P�RMIT�'EE CALCULATION(S) <br /> BASED OFF-<2002 STATE STATUE <br /> ❑ Yes,this section applies <br /> The repfacemeot of a Residentiai fixiure or apoliance that mee(s all three oPFhe following requirements: <br /> 1. Does not requir�modification to electrical or gas service. <br /> 2. Has a total cost of�500.00 or less,excludin�the cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeo�vner or ticensed contractor. <br /> Skip nexI section;if this applies; Cost of Permit $ 15.00 <br /> State Surcharbe $ �.00 <br /> Mail-Tn Fee(If Applicable) $ 2.00 <br /> '1'otal Permit I'ec .Fi <br /> �� � PERMIT FEE CAI,CULATION(S�—JOBS OVER$SU0:00 <br /> If above does not apply;folio�v buidelines below: <br /> 1. CON`�'RACT PRICE *is 1.25%of contract price with a(i�linimu�tx I�ee of�50.00) <br /> `�'��1,'��;�+1',, ��'�- x .0125� � �1_,�'�� �-�-�.; <br /> ----�'----__.._......__. <br /> (contract price) (minimum$$0.00) <br /> 2. STA'1'E SDRCHARGE ;_:�� �,��, <br /> I���C%�_�;. C�,���. x.0005 � <br /> (COntr,fCt pfiCC) <br /> 3. POSTAGE&HANDLiNG(Only orc Mail-Cn Applications) $ 2_00 <br /> =t. TQTAL P�R1�11T r�E(Add Lines 1-3 Above) $ ���7'"' -�._.%�'' <br /> ° * CON�I�R.ACT PRICE or JOI3 COST me2ns the actual or estimated dollar amount charged for the <br /> permitted�vork including materials,labor,proTit,and other fixul costs. It is the amount to be charged <br /> to the customer for the work done. If any material, equipment, labor or installations are fumislied by <br /> the owner, tenant or any other party,tl�e reasonable market value of such items must be added to the <br /> estimatecl cost or contract price for permit fee purposes. In d�e event that there is a dispute on tlie <br /> amount of the job cost, the City may requesi the submission of a signed copy of the aetual contract. <br /> MECHANICAL PERMITAPPLICATION AGREEMENT <br /> "I'he undersi�ned hereby applies to the City for issuance oY a Meclianical Permit, agrees to do all <br /> work in strict accordaf�ce ��rith the ordinances of the City <uid the regulations of die State of <br /> Minnesota, and ceF•tifies that all statements made on this application ai�e complete, true and <br /> p <br /> con•ect. � <br /> / <br /> —� '� � A •. <br /> i `� <br /> � ' 1 ( J <br /> Applicant's Signature: /('�'-;z��1�f,Ct�'�_ ������`� -�1,��� Date: � � ` ( ��- ��� <br /> J " <br /> / � <br /> G` <br /> 3 <br />