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� -PERMI'T FEE CALCULA'T'ION(S) <br /> _BASED OFF - 2002 STATE STATUE <br /> ❑ Yes,diis section applies <br /> 'I'he replacement of a Residentiial tixture or appliance that meets all three of the following requirements: <br /> 1. Does not require modifiication to electrical or gas service. <br /> 2. I las 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 homeowner or licensed contractor. <br /> Skip next seclion, if this applies; Cosl of Permit $ I 5.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) 9� 2.00 <br /> Total Permit Fee �_ <br /> �� PERiV1i"l, �EE C,�+i_C uLAT1�i�i�S) -30'rs� O'v ER $�v0.v� --� <br /> li'ab���=_-�1oes not apply;follow guidelines below: <br /> 1. COn'TRACT PRICE * is 1.25%of contract price with a(Miui►num Fee of$50.00) <br /> �� ��� `/ x .O125 $ � � � �/ _ <br /> (contract pricc) (minimum.9',511.1111) <br /> 2. S"CA'TE SURCtIARC1. �/ S'S�� <br /> �11 U;�v X .000s x f--- <br /> � (conl[acL p[ice) <br /> 3. POSTAGE& HANDLING(Only on Mail-In Applications) $ 2•���___ <br /> �F. �i'€3TAL PEIZMI't' REL(Add Lines I-3 Above) $ <br /> �y� � <br /> ■ * CON�I�RAC"I, PRII'� �r JOa COST means the actual or estimated dollar amount charged for thc <br /> permitted work includins�ma�erials, labor, profit, and other lixed costs. It is the amount to he charged <br /> to the customer for the work done. If any material, equipment, l�bor or installations are furnished by <br /> the owner, tenant or any other parly, the rcasonable markel v�lue 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 dis��ule on the <br /> ai��wcnt i�f the job a�sL the City may request the submission of a signed copy of thc actual cuntract. <br /> MECHANICAL PCRMIT APPLICATION AGRELMENT <br /> "l�he undersigned hereby applies to the City �for issuance of a Mechanical Permit, agrees to do all <br /> work in strict accordance with the ordinances of �lle City and the regulations of� the State of <br /> Minnesota, and certities that all statements made on this application are complete, tcue and <br /> co rrec>.. <br /> �,� � ��,1v�� 10- �- ) � <br /> npplicant's Signature� � Date: <br /> Reset Form <br /> 3 <br />