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� r <br /> �'EI2MI'd' FEE �'E�LCLIL�'�'�ON(S) <br /> 20(}2 Staf� Stataate ❑ �'�s 'I'h,is Sec�ion�ppdies <br /> The replacement of a Residential fixture ar appliance that meets all three of the following requirements: <br /> 1) Does not require modification to elech-ical or gas service. <br /> 2) Has a total cost of�500.00 or less; excludin� the cost of the fixture or appliance: <br /> and <br /> 3) Is improved, installed or replaced by the homeowner or licensed contractor. <br /> Skip next section; Cost of Permit $ I 5.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee $ 1.�0 <br /> If above does not apply, follow duidelines below; <br /> �. �'«�a��•�et �'�•ice* �s .0125°io of job wi1:h a l�i�����lurrt �+ec of��35 00� <br /> c-��, c�� _x .0125 y "' — - <br /> .� 1 �JJ <br /> (contract price) (minimu�T��35.00} <br /> 2. Sta#e ��rcilar�e. ** A.dd the State Building Code Division a l��inima�rra �'e,e Qf(3� �Q�} <br /> ��� � x .0005 $ ��� <br /> (contract price) (nui�imum$ .50) <br /> 3. UQstaQe a�d ����adlar� (Otidy maif-irr ap�Zications) � ���� <br /> 4. '�C3��L P��I���' ��� (Add ]ines 1-3 above) � _>� �"ti <br /> *COT�TP.ACT PRICE o�.JOB COST mear.s the actual or estimated dollar amount charged for[ne pem�itted work including <br /> materials,labor, profit,and other fixed costs.1C is the amount to bc charged to The cus(omer for the work clone. If any material, <br /> equipment, l�bor,or ir�stallativn is furnished by thc owner,tcnant or any other party the reasonaLle marlcet value of sucti items <br /> must�be�dded to the estimated cost or contract price for permit fee purposes. In the event that t�here is a dispute on the aimount of <br /> thejob eost,the City may request the submission oi a si�ned eopy of the actual contract. � <br /> **The STATE SURCI-IARGE is.0005 of the contract price under S 1,000,000 or$.50-whichever is greater. For valuations over <br /> a 1,000,000 call the Department of Inspectional Services for the price. <br /> The undersi�ned hereby applies to the City for issuance of a Mechanical Pern�it,agrees to do all work in strict accordance with <br /> the ordinances of che City and the regulations of the Minnesota State Building Code,and certifies that all statements made on this <br /> appiication are complete,true and correct. <br /> � Applicant's Signaty�e: �-1�-�� ;,� Date: <br /> Approved By: � Date: <br /> 3 I <br />