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� 9529331869 18 07 58 06 15 2015 4/4 <br /> \ <br /> PERMI f PEE CAL,CULATION(S) <br /> BASFD OFF-2002 STATE STATUE <br /> � Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all threc 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;excludine the cost of the tixture or appliancc:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor. <br /> Skip next section,if this applies; Cost of Permit $ I5.00 <br /> State Surcharge $ 5.00 <br /> Mail-in Fee(If Applicable) <br /> Total Permit Fee ��•Q� <br /> ERMIT FEE CALCULATION S -'JOBS OVER'$500.04 �..-�" �-`'� <br /> � <br /> If ab e does not apply;follow gu� �Itaes below: <br /> 1. ONTI2ACT PRICE *is 1.25%of contract price witli a(Minimu ee of$50.00) <br /> . i25$ <br /> (comrac�pricc) (minimant$5D.00) <br /> 2. STATE SURCHARGE <br /> '� x.0005 $ <br /> co ct pricc) <br /> 3. POSTAGE&EIANDLING(Onl n Mait-In lications) $ 2.00 <br /> 4. TOTAL PERMIT G(Add Lines 1-3 Above) �_ <br /> ■ * CONTRACT PR or JOB COST means the actual or estimated dolla ount charged for the <br /> pern�itted work ' cludiilg materials, labor,profit,and other fixed costs. It is the a� nt to be charoed <br /> to the custo r for the work done. If any material,equipment, labor or installations a urnished by <br /> the owne tenant or any other party,the reasonabEe marEcet value of such items must be a to the <br /> estim d cost or contract price for pern�it tee purposes. In the event that there is a dispute o the <br /> a nt of the job cost, the City may request the submission of a signed copy of the actua] contra . <br /> MECHANTCAL PERMIT APPLICATION AGREEMENT <br /> The undersigned herehy applies to the City for issuance of a Mechanical Perniit, agrees to do all <br /> work in strict accordance with the ordinances of the City and the reeulations of the State of <br /> Minnesota, and certifies that all statements made on this application ai•e complete, true and <br /> correct. <br /> Applicant's Signatura�..�....___i'2� (J C!�� Date: OCo IS �� <br /> 3 <br />