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PERM(T �EE CALCULATION(S) � <br /> _________ BASED OFF -2002 STATE STATUE <br /> ❑ Yes,this section applies <br /> The replacement of a Residential f ixture or appliance that meets all three ofthe fiollowing requiren�enls: <br /> I. Does not rec�uire modification to electrical or gas service. <br /> 2. Has a tol�_al_�ost of'$500.00 e-�less;excludine the cost of the fixture or appliance: <u�d <br /> 3. Is imp���.�,����,i, on�;lalfed or repfaced by the homeowner or licensed contractor. <br /> Skip next section, if this ap�lies; Cost of Pennit $ �S.pp <br /> State Surcharge $ 5,pp <br /> Mail-In ['ee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> PERM[T FEE CALCULATfON(S) —JOE3S OVER $500 00 <br /> IPabove does not app{y; follow guidelines bclow: <br /> l. CONTRACT YRICL * is I.25�%of contract price witi�a(Minimum I�ee of$50.00) <br /> ( � �� \ �j �S <br /> X � V � � .0125 $ � U � � <br /> (contract price) (minimum$511.1111) <br /> �. s7�A�r�sukcE�.AKcr, � � O � �i — `I a� <br /> X.000s �_ _-------- <br /> (contract price) <br /> 3. POS�'A:;;:.?: �i'���i�[,ING(Only on Mail-In Applications) $ 2.00 <br /> � � � �� <br /> 4. TO"1'Al, PI�;RMIT ['EE(Add Lines 1-3 Above) $ <br /> ■ * CONTRACT PRIC�; or JOB COST means the actual or estimated dollar amo�ml cha�ged for ihe <br /> ��ermi(ted work including malerials, labor, protit, and other tixed costs. I1 is the amount to be charged <br /> to the customer fi�r the work done. If any material, equipmcnt, labor or installations are furnislled by <br /> lhe owner, tenant c�E� ai:y other party, Uie reasonable market value of such items must be added to the <br /> estimaled cost i,�� contract price for p�nnil fee purposes. ln the event that there is a disputc on the <br /> amounl of the job cosC, the City may rcquest the submission of a signed cupy of the actual contract. <br /> MECHANICAL PCRM(T APPLICATION AGREENtENT <br /> 'I,he undersigned hereby applies to the City 1or issuance of a Mechanical Permit, agrces t�� do all <br /> work in strict acc����i:�,�:��� with the or���linances of the City and the regulations of the State oi� <br /> Minnesota, and cei�tii���s �i�a' all statements made on this application are complelc, U�ue and <br /> co rrect. <br /> � <br /> f1� IicanL's Si nalure: _ � �` � �_� <br /> I P � � Datc: � <br /> Reset Forr�c <br /> 3 <br />