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a <br /> PERMIT FEE CALCULATION(S) <br /> BASED OFF -2002 STATE STATUE <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;ercludins the cost of the fixture or appliance: and <br /> 3. Is improved,installed or replaced by the homeo�vner or licensed contractor. <br /> Skip next section, if this applies; Cost of Permit $ 15.00 <br /> � � 1,�5�c�.l\ �_S �c��._ `��.n C��S State Surchar�e $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> `��r��,r E(��c�C e C°p�3 F�� �l eX �` ��� C�-v� Total Permit Fee �,�`�(.� <br /> �'5-b"��� — . h�C;C'K�'�'_ <br /> PERMIT FEE CALCIJLATION(S —JOBS OVER $500.00 <br /> If above does not apply; follow guidelines below: <br /> 1. CONTRACT PRICE * is 1.2�%of contract price with a(Minimum Fee of��0.00) <br /> x .0125 $ <br /> (contract price) (minimum 5�0.00) <br /> 2. STATE SURCHARGE <br /> x .0005 $ <br /> (contract price) <br /> 3. POSTAGE&HANDLP�IG(Only on iv1ai1-In Applications) � 2.00 <br /> 4. TOTAL PERNIIT FEE(Add Lines 1-3 Above) $ <br /> ■ * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charQed for the <br /> permitted work including materials, labor, profit, and other fixed costs. It is the amount to be char�ed <br /> to the customer for the work done. If any material, equipment, labor or installations are fum:shed 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 si�ned copy of the actual contract. <br /> MECHANICAL PERMIT APPLICATION AGREEMENT <br /> The undersi�ned hereby applies to the City for issuance of a Mechanical Permit, aarees to do all <br /> work in strict accordance with the ordinances of the City and the regulations of the State of <br /> Minnesota, and certifies t t all statements made on this application are complete, true and <br /> correct. <br /> i <br /> Applicant's Signature: � Date: 1 �L �f���-- <br /> � <br /> Reset Form ��,�� <br /> , <br /> 3 <br />