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12/01/2004 15:02 FAX 76� 591 6071 IVERSON f�003 <br /> ` ; <br /> . � <br /> PERMIT I'EE CAT�C�.,ATTON(Sl <br /> ZO�� State Statute ❑ I'es, This Section Applies <br /> The replacement o� a Residential fi.�ture or ap,�liance that xneets all three of the following � <br /> requireme�,ts- <br /> Z) Does not require modification to electrical or gas service. <br /> 2) Has a total cost of$500.00 or less; excl,�, udin� the cost of the fixture or appliance: <br /> arpd <br /> 3) Is improved, instal�ed or replaced by the homeowner or licenced contractor. <br /> Skip next sectxon; Cost of Permit S 15.0 <br /> State Surcharge S .SO <br /> Mail In Fee S 1.5o <br /> If above does not apply, follow guidelines below: <br /> 1. Cont�-act Price* is ,0125 % of job with a Minimum Fe� of ($3�.001 <br /> �-{%�� � �� x .0125 S <br /> (contract price) (m�n�mum $35.00) <br /> 2. State Surchar�e. '�* Add the Srate Building Code Division a (�I'inir,�um Fee of$ .50) <br /> � <br /> �2�0 x _0005 5 <br /> (contract price) (miniraum$ ,50) <br /> 3. Postag,e and Handlin� (On.ly mail-in applications) S 1. <br /> 4. TOTAL PE�2MT1 FEE (Add lines 1-3 above) $ <br /> � CONTRACT PRICE vr JOB COST means the acn�al or esti.ma�ed doliar amo�charged for the perm.itted <br /> work inchiding macerials, labnr,profi�,and orher fixed costs. i�is the amount�o be cJ�arged to thc cus�omer <br /> for the work done. If any macerial,equiprraenc, labor, or inscallaaon aze fuinL�ed by the owncr, tenant or <br /> any other parry rhe reasoaable market value of such items nlust be add�d to rhe estimated cos�o� contrac� <br /> price For p�rmi['fee purposes. In the e�-e�t that thcrc is a dispute on rhe amount oi the j�b cos�, the Ciry may <br /> requesc ehe subrnission of a sigr,c:d capy of the acmal contract. <br /> ** The STATE SCJRCHARGE is .00lJS of[he conrract price undcr$1,000,00p or 5.�0- whichever is greater. <br /> For valuations over$I,000,000 call rhe Departmcnt of Inspeccion Services Eor�he price. . <br /> The undersigned hereby appl�es [o the Ciry for issuance of a P�umbing Permat, agrees to do al1 <br /> work in strict accord,ance with the ordinances of the City and the rea-ularions o� the Scate of <br /> Minnesota, and certifies rhat all stacements made on this application are complete, true and <br /> cozrecc. <br /> � � <br /> .A.pplicant's Signa ��' Date: 2 ���'!� <br />