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FtE�t.�9T FF,E CA�.CUL.AT10NiS) <br /> :'002 State Statute � Yes This SF�tico ,�pclies <br /> TL�replacemr.nt of a Resid�r.tiaf fi.ture or applir�n�e tha:meets all threc��f the following requirements, <br /> 1 j Does not r;yuire modificai:on to e;.cvi�s] or gas sen�icc <br /> ?) Hns a totnt cost of�SDO UO or less; zxcludi�the cost of the fixture or appliarace: <br /> an d <br /> 3) ls im�roved, ins�t371ed or replaced 1,�.�th�hom�o�rner or l�censzd contra�:.tor. <br /> Skip next secrion; Ccst of Prrmit $ 15.00 <br /> �ture Slirc;�a oe $ 50 <br /> ti1�ii-Jn �ee $ 1.50 <br /> :I above does not appty, foliow�guidelir,cs below: <br /> I. Contract�'rice" is .O l25% of jab with a blin.mum Fee of(S35•OQ) <br /> _ I �f'C� .��-'x .ol�s � 3J. �> <br /> icunc:act pr�cel (rn,nirrum S35.t�) <br /> ' State Surcharee. "k Add the 5tate Binlding�`o�le Cii�ision a Minimum �ee o2'(S .SU1 <br /> 1�C�� �Z� ?; .000s � , �F' C; <br /> (:antr�cc pncc,i �;rt:n:mum 5.SG) <br /> � Posta�e and Handlin��Only rnarl-rn upplicUti��ns> � _ � 5� <br /> �1 TOTAL PERI�IIT FL:E(Add lines t-3 ah,:vc) $ 1 y , ��/ <br /> •�O�TR�CT PRICE or JOB COST mcans tF,c actuul or escnatcd dollu amount chareed i�or the�ezmitte����ork incf��ding <br /> a.a�crisl�,labor,prof:t.anj other fi:td coiTs.I�'.s iMc amo�in[co bc chargcd to thc customer for th:�work donc, If any n•�arcrial, <br /> �.�uipmcnt,lshor,or instal'iation�;furni�hcd by thc ownc:,ter,anc or any o�hcr pam�the r�oaab�z mruktt�aluc of svch itcr.zs <br /> must be adde�i to?h_es:in.ated cost or con�an price far pemi�t�ee purposes !n the even�tha[there is s di5pute on cfte an�.ount of <br /> in�;�r co>t,the City ms}'requcst thc submission of n s����ed�op;�oftRe actual cuntrut. <br /> •• Tl�c STAT'E SLRtCH.;..RGE is.OQOS of the con?ract pr�cc�r.cer 31,00QOG0 er 5.30-whic`icv:r is gr�er For ���laat�.on_over <br /> �'.,OOC,��O�cs�ll tho DepaYtment ot Jns�ecti�nal serv�ces ior t:.c pricc. <br /> Tht unc+er�igr.eC he�zby a�pi�as�o the Ciry far�j3U271Cc OPd;�:cChanic;u per.r.it,ag..s to c'o a'.l�.tier�:in saiCi a:curdance Nith <br /> rh�orcinanc:s of[h:City::n�the regui.uions of the Minnrsota S[�tc Buildlrg Codc,and certifles th.at al s�aerments msdc on this <br /> appli�acion are complctc,mic and cortect. <br /> ? _. _ _,`,1. <br /> �ppl�cant's Signature: ------ —:----- - .u�� ��------- Dnte: �3��� <br /> .�Pproved By. Date: <br /> 3 <br />