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'' 952�J331869 20.01:11 03-24-2014 4/4 <br /> PERMIT FEE CALCULATION(S) <br /> BASED O�'P -2002 STATE'STATUE <br /> ❑ Yes,this section applies <br /> The rcplacemcnt of a Residential fixture or aQ�yliance 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;excludin�the cost of the fixture or appliance:and <br /> 3. ls improved,installed or replaced by the homeowner or licensed contracror. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> PERMIT FEE CALCULATION S -`JOBS'OVER$500.00 <br /> If above does r�ot apply;follow guidelines below: <br /> 1. CONTC2ACT P12ICE *is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> ��'�=U�f x.0125$ Jl� OC: <br /> (contract pricc) (minimum$50.00) <br /> 2. STATE SURCHARGE <br /> x.0005 $ ( , C> �� <br /> (contmct pricc) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMiT FE�(Add Lines l-3 Above) $ �-� 3� �' �`� <br /> • * CONTRACT PRICE or 70B COST means the actual or estimated dollar amount charged for the <br /> permitted work including materials,labor,profit,and other fixed costs. It is the amount ro be charged <br /> to[he cus#omer for the work done. If any material, equipment, labor or installations are fumished by <br /> the owner, tenant or any other party, the reasonable market vaiue 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 /> MECHANICAL PERMIT APPLICATION AGREEMENT <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 ordinances of the City and the regulations of the State of <br /> Mi�mesota, and certifies that all statements made on this application are complete, true and <br /> correct. <br /> . / - � <br /> � <br /> Applicant's S�gnature�_ `=-�,-'1..<G\ �C �- .r.'iw�>�:._�i�.t,� _ Date: ''- ��.'�( /L�� <br /> '� <br /> 3 <br />