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1-18-05; 10:58AM +9522494616;# 4 <br /> Jan-18-Z005 11:Olam From-GITY UF ORONO +y5ZZ484616 T-45Z P.004/006 F-87U <br /> �a . <br /> PERMIT FEE CAY�CY]LATION(5) <br /> 2002 State Statute ❑Yes This Section Applics � <br /> The replacement of a Residential fixture or appliance that meets all thtee 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;excl�the cost of th�fixture or 2ppliance: <br /> and <br /> 3) Is improved,installed or replaced by the homeowner oz licensed contractor. <br /> Sidp next section; Cost of Pertnit $ 15.00 <br /> State Surcharge$ .50 <br /> Mail-Tn Fee $ 1.50 <br /> I�above does not apply, follow guidelines below: <br /> 1. Contract Price* is .0125%of job wiih a Minimum Fee of($35.00� <br /> ����� �._� x ,0]25 $ 1��'�. 7`7 <br /> (connact price) (minimum$35.00) <br /> 2. State Surchar�e. '�*Add the State Building Code Division a Minimum Fee of(S.50) <br /> , , <br /> �����i .i��, ,( l_%x.00OS $ ��� ��� <br /> (conaact p►icc) (m;nimum$.50) <br /> 3. Posta�e aud Handlin� (Only madl-in applicatiolis) $ 1.50 <br /> 4. TOTAL PERMTT FEE (Add lines I-3 abovo) $ _/�% �, e-l�_____ <br /> *CONT.24CT PRICP or 70B COST meaa�the a�tual or estimated doll�r amouttt chaTged for thc ncmnitted work in�luding <br /> m��erials,labor,profit,and other fixed costs.I�is the amount to be charged to the customer for the work done.If any materisl, <br /> equipmcnt,labor,or ins�alla�ion is fumished by the owner,tenant or any ocher party che reasonable markcs valuc of such icems <br /> must be added to the cstimatcd cost or contrac�price for permit fee purposes. ln the event[ha[th�rc is a dispute on the amount of <br /> the job cost,the Ciry may requcst thc submission of a signed copy of[he actuAl coatract. <br /> '"The STATE SURCHARGE is_0005�f ihe contract pnce unde�S 1,000,000 or$.50-whichever is grcatcr.For valuations ovcr <br /> �I,000,000 call[he T�epartment of Inspcctional Serviccs for the price_ <br /> The undersigneQ hereby applies to the Ciry for issuance of a Meehanieal Permi[,agrees to do all v��ork in scriec accordanee wi�h <br /> thc ordinanccs of thc Ciry and the regulations of[he Minneso�a Statc Building Code,and certifics that all statements made on this <br /> �pplieation are comple[e,[rue and correct. <br /> � �, <br /> Applicant's Signature: �J�����- �i�'l.%�' �� �������� i` Date: l'���`� <br /> Approved By: Date: <br /> 3 <br />