Laserfiche WebLink
F'}�itlt�fTT T��,E'CALCUI,ATICJN(S) . `'` <br /> �. g�iSEt�UI�F - ' <br /> � ___Z002 ST�TE �T��Tt_IE ; <br /> -------- ; ;:�,... . <br /> -- - -- : <br /> ❑ Yes,this section applies <br /> Tiie rep(acement of a Residential fixture or aopliance tiiat meets al!three of the foflowing requirements: <br /> 1. Does not require mociification to electricaf or��s seivice. <br /> 2. Has a total cost of$500.00 or less;excludine the cost�f the fixture or appli�nce: and <br /> 3. ts improvetl, installed or reptaced by the hoineoi�+ner or ficensed contractor. <br /> Skip next section, if this applies; Cost of Pennit <br /> $_ 15.00 <br /> State Surcharge R 5� <br /> Mail-In Fee(f f Applicable} g _ 1 5� <br /> Tots�l Permit �ee � <br /> j` - --______���t��``�������,�u���r�a�rC�)�-`►�$� o��� ���"��j.� <br /> - ---��� <br /> 1 f ahnve does not apply; follow guidelines below; <br /> 1. CONTRACT PRICE "` is I.25"/0 of contract price with a{Minimnm Fee of$35.0p) <br /> a, � <br /> � Co . - X .�,25� �i5 � <br /> � (contractpricc) --(minimum.R35.0�} � <br /> 2. STATE SURCHAR(:� **Add the State Bld�Code Div. Su►•chaege(Menimum r'ce of�.50) <br /> ¢�� �.,� �� �'� <br /> --_�"�_ �t�-��_�-----x .Q(lnS 9; _l / <br /> (contract pnccj (minimnm 9; .S(?) - ----- <br /> 3. f'OSTAGr&Nf1NDLING(nnly on Mail-�n Applicationsl ,y; <br /> LSp <br /> 4. TOTAL PERMiT FEF.,(Add Lines l-3 Above) � " �� <br /> " '� C'ONTi2AC'T' PRI('F_. �r JOB COST means the actual �r estimated dollar amount chart;ed for the <br /> permitted work including materials, labor, Urofit,and other fi�ced costs. !t is the amount to he charged <br /> to tlte cust�mer for the work done. If aity material, equipn�ent, I�bor or installations are fiu'nished hy <br /> the owner, tenant or any other}�arty, the reasonable market value of suci� items must be added to the <br /> estimated cost or contract price fo�- permit fee purposes. in the event that there is a dis}�ute on the <br /> �mow�t of the job cost, the City may re9uest the subn�issi�n of a signed copy of the aetua.l contract. <br /> • '"''`Tlie STATF SiJRCHARGE is.(]005 of the Building Depart�nent at(9S2)249-4(Qp for thc price. <br /> (. '�_�:,_�. �r�����r��L p��;���'��:���;�cA�rlc�r� �,G���:f. . : <br /> "l�he ttnde�:�i�ned hereby app(ies to the City for issuance c�f'a Mechanical Pe�nit, agrees to cIo a)1 <br /> �vorl< in strict accordance with the ordii�arlces of the (�ity and ihe regulations oF tfle State c�f <br /> Minnesota, and certifies that all stat.ements made on thi� application are complete, true and <br /> cc�l-reci-. <br /> � <br /> npplicant's Signatu�•e: _ ►�,-_ ��1�. l-_ Date: � � <br /> _ --�--�-��--- <br /> ����ti�a� <br /> � <br />