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;. PERMiT FE�CAL�ULATi4N(S) _ <br /> - �3ASED OFF.2002 S'X'ATE STATUE _: <br /> ❑ Yes,this section applies <br /> The repiacement of a Residential fixture or ap lip ance that me�ts all three of the following requirements: <br /> i. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;exc[udins the cost of the fixture or appliance:and <br /> 3. Is improved,instalied oz replaced by the homeowner or]icensed contractor. <br /> Skip next section,if this appfies; Cost of Permit $ 15.00 <br /> State Surcharge $ 1.00 <br /> Mail-ln Fee(lf Applicable) $ 2.00 <br /> Total Permit F'ee $ <br /> �T , I'�RIYII�'�'EE�;A�LC[JLATION(S)-�485 OV�R$50Q,00 �-���� -�� <br /> If above does not apply;follow guidelines betow: <br /> 1. CONTRACT PRICE * is 1.25%of coniract price with a(Minimum Fee of$50.04) <br /> '�91�.� � X.otzs$ �— <br /> (contrect price) (mimmam$5 .00) <br /> 2. STATE SURCI3ARGE ���� � �� <br /> x.0005 $ <br /> {contract price) <br /> 3. POSTAGE&HANDLING{Only on Mail-1n Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE{Add Lines 1-3 Above) S ��. �f <br /> ❑ * CONTRACT PRICE or JOB COST means the actual or estirnated doIlar amount charged for the <br /> permitted work including materials,labor,profit,and other fixed costs. It is the amount to be charged <br /> to the customer for the work done. If any material, eyuipment, labor or installations are fumished 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 signed copy of the actual contract. <br /> lV1ECH�.NICAL 1'ERM�T APPLICA'I7(?N A.GR:�EIvIENT : <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all <br /> work in strict accordance with the ord'vnances of the City and the regulations of the 5tate of <br /> Minnesota, and certifies that all statetnents made on this appIication are cornplete, true and <br /> correcL <br /> /�-. <br /> Appiicant's Signature: � � � Date: �v�. l''rj - /��, <br /> 3 <br />