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' From:COUNTRYSIDE HEATING & COOLING 763 479 2518 10/09l2013 07:26 #823 P.003/003 <br /> --- -- —----- � <br /> PERMIT�'EE CALCUI,ATT�JN�S� � <br /> BASED OFF 2002 STATE STATUE <br /> ❑ Xes,this section applies <br /> T71e repk�cemer�of a Reside»tial f�ctiae or app}iar�e that meets all t}ree ofthe follown�g reqw-emez�s: <br /> i. Does not requac modifi�cation to electrical or gas service. <br /> 2. Has a total cost of$500,00 or�ss;exc ' Lhe cost ofthe fixtu-e or app�e:and <br /> 3. Is ur{�roved,ir�alled or mplaced by the horreowrrr or l�ensed cortractor. <br /> Sk�next section,i�'this app}ies; Cost ofPerm't � 15.00 <br /> State Surcharge S____ 5�00 <br /> Ma�InFee(IfApplicab]e) $_ 2.OQ <br /> Total Peimft Fee S <br /> --- — - ----�-__ <br /> PERMIT FEE CALCULAT'I(JN{S)-JOBS �VER$500.00 � <br /> ---- -- __ __ _v�� <br /> Ifabove does not apply,follow�leli�ees be�w: <br /> i. CONTRACT PRICE "is 1.25%of cordract price with a(Mininsim Fee of S50.00) <br /> DQ�J�v. c�'J x.Oi25S (�lEi , � �l <br /> (corRract pr�c) (�nnnS50A0) <br /> 2. STATE SURCHARGE <br /> �L`�� �� X.000s s �, <br /> (c cNract prT e) <br /> 3. P�STAGE&HANDIdNG(Only on Ma1-In App}ications) T�____� 2.00 <br /> 4. TOTALPERMITFEE(AddLaus 1-3 Above) S ���' 00 <br /> • * CON'IRACT PRICE or JOB COST means the actual or esti►reted dol}ar azmurt charged for the <br /> pem�ied woc�inch�di�g materia�s,labor,profit,and other fixed costs. It is the amourd ta be ch�ged <br /> to t}ve custorrer for the wociz dorbe. If arry rrraterial,equip�rrrt,]abor or imst.all�ioms are fixnisl�d by <br /> the owner,ter�ant or any other p�ty,the reasor�ab]e rreticet vah�e of such$ems rrntist be added to the <br /> estvreted cost or cordract price fnr pec7nrt.fee purposes. In t}�e ever�.tlrat there is a dispute on the <br /> annurd of t�u job cos1,the Ci�.y may request the s�rr►issmn of a signed copy of the adual cor9rad. <br /> MECHANICAL PERMiTAPPLICATiO?+1 AGREIIVIENT <br /> TY�e w�iersigned hereby applies to fl�e Cicy for issuance of a Mechanical Pem�, agrees to do all <br /> wo�c in s[r�t accordance widh the ordnra»ces of the City and ii�e reguhtions of 1� State af <br /> Minnesota, and cerh�ies that all statemerns made on ths app}ication are camplete, true and <br /> correc� <br /> Applicant's Sig�iature: �2y��"' `�� Date: �� ��'��� <br /> 3 <br />