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. �►. ' � PERMIT FEE CALCULATION(S) ' �� BASED OFF - 2002 STATE STATUE ` ❑ Yes,tliiv sectiun applies The replacetnent of a Residential tixture or appliance that meets all three of tlie following requirements: I. Does not require moditication to electrical or gas service. 2. Has a total cost of$500.00 or less;excludinQ the cost of the fixhire or appliance:and 3. Is iinproved,installed or replaced by the homeowner or licensed contractor. Skip next section,if this applies; Cost of Pennit $ 15.00 State Surcharge � 5.00 Mail-In Fee(If Applicable) S 2.00 Total Permit Fee $ PERMIT FEE CALCULATI4N�S� —�C�BS (J�ER $500.00 � II above does not appty, fol(ow guidelines below: 1. CONTRACT PRICE *is 1.25%of contract price with a(Alinimum Fee of$50.00) $1,950.00 x.0125 � (contract price) (minimum$50.00) 2. STATE SURCHARGE $1.950.00 x.0005 $ (contract price) 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ ■ * CONTRACT PRICE or JOB COST ►neans die actual or estiinated dollar amount charged for the peiniitted work including materials, labor, protit, and c�tlier tixed costs. It is the amount to be charged to the customer for the work d�ne. If any inaterial, equipment, labor or installations are furnished by the owner, tenacit or any other party, tlie reasonable market v11ue of such items must be added to tlie estimated cost or contract price for peimit fee purposes. In the event that there is a dispute on the amount of the job cost, the City may request the submission of a signed copy of the ach�al contract. MECHANICAL PERMIT APPLICATION AGREEMENT The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all work in strict accordance with the ordinances of the City and the regulations of the State of Minnesota, and certifies that all statements made on this application are eomplete, true and correct. Applicant's Signature: ��Gli�'� .L.-/v�.r2�� Date: 4I30/15 3