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, . <br /> __ -- -- <br /> — -- - <br /> � �� PF�RMIT���'CE CA�CULA'TION(S) <br /> BASED OFF -2002 STATE STATUE <br /> ❑ Yes,this sectiou 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 ar gas service. <br /> 2. Has a total cost of$500.00 or less; excludin�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 appiies; Cost of Permit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-in Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> PE��T�'E :�����'�Cl ��i�� �_ ���+5��:�... .��,..... "���..'. <br /> if above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> ���%�� x .0125$ , �/ � �'�/ <br /> (contract price) (minimum$50.00) <br /> 2. STATE SURCHARGE <br /> ���� � � x.0005 $ � ��� � <br /> (contract price) <br /> 3. POSTAGE&HANDLTNG(Only on Mail-in Applications) $ 2.00 <br /> —, %" <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ � �� � <br /> ■ * CONTRACT PRiCE or JOB COST means the actual or estimated dollar amount charged for the <br /> permitted work including materials, labor, profit, and oCher 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 /> . ,.: _ <br /> ' ��s���� ��.�r �Iw..� ° ��"a�,,%9�, :',�. „ <br /> �,�,,, <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 /> Applicant's Signature: Date: � � /� <br /> 3 <br />