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1 , <br /> � � � � PERMIT FEE CAT:,CULATION(S) � � � <br /> BASED OFF - 2002 STATE STATUE <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or a�pliance 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;excludine 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 Permit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Appticable) $ 2.00 <br /> Total Permit Fee $ <br /> � � ��� �'.ERMIT FEE GALCULATION(S)�-JOBS O�ER$�00.00 �� <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE * is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> �VU��uI.J x.0125 $ �V•�� <br /> (contract price) (minimum 550.00) <br /> 2. STATE SURCHARGE �� (�, <br /> ��' x.0005 $ � �"�� <br /> (contract price) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ �: i'� <br /> ■ * CONTRACT PRICE or JOB 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 to be charged <br /> to the customer for the work done. If any material, equipment, labor or installations are furnished 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 /> r A����. � ����� '��J,i��:i ����,I✓������1::+������/� ,�arr�' � ����,i �.: s y-;.: <br /> ✓/ � <br /> .�, , e� � �..c f..�'�' :n.. <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 /> Minnesota, and certifies that all statements made on this application are complete, true and <br /> correct. <br /> ;��, <br /> � 08/23/11 <br /> Applicant's Signature: � � -f - Date: <br /> �, _�� <br /> � <br /> ;����,..�eset Form ��� <br /> 3 <br />