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9529331869 1 7 53 01 07 24 2014 4/4 <br /> PERMIT FEE CALCULATION(S) <br /> BASED OFF-2002 STATE STATUE <br /> ❑ Yes,[his section applies <br /> The replacement of a Residential fixture or appliance ihat meets all three of tl�e following requirements: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excludinQ the cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor. <br /> Skip next section,if this applies; Cost of Pern�it $ 15.00 <br /> State Surcltargc $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Pcrmit Fec $ <br /> PBItMIT FEE CALCULATION S �JOBS OVER$500.00 <br /> lf above does not apply;follow guidelines below: <br /> l. COIVTRAC'I'PRICE *is 1.25°/o of contract price with a(Minimum Fce of�50.00) <br /> -�.�� ;�l x.0125$ ����..�`7 <br /> (controct pricc) (minimum SSO.QO) <br /> 2. STATE SUFtCT�ARGE <br /> ���i Ol> x .0005 $ !�_ .}`� <br /> (contmct price) <br /> 3. POSTAGE&HANDLTNG(Only on Mait-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ �'��".`'���.J <br /> ■ * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the <br /> permitted�vork 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 furnished by <br /> the owner, tenant or any other party,the reasonable market vaiuc 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�pute on the <br /> amount of the job cost, the City may request the submission of a signed copy of the actual contract. <br /> MECHANICAL I'ERMIT APPLICATION AGREEMENT <br /> Tfie undersigned hereby applies to the City for issuance of a Mechanical Permit, agrces to do all <br /> work in strict accordance with the ordinances of the City and the regulations of the State of <br /> Minnesota, and certi6es that all statements tnade on this application are complete, true and <br /> con•ect. <br /> � �� � � <br /> Applicant's Signature: ��1�J t�� � _,� ' Date: �"���� ���-�- <br /> 3 <br />