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9529331869 14 07 29 08-14-2015 4!4 <br /> PFRMIT FEE CALCULATION(S) � <br /> BASED OFF-2002 STATE STATUE <br /> ❑ Yes,this section applies <br /> Thc replacement of a Residential fixture or appliance that meets all three of die following requirements: <br /> l. Docs not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excludinQ the cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or[icensed contractor. <br /> Skip next section,if this applies; Cost of Pcrmit $ 15.00 <br /> State Surcl�arge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> PERMIT FEE CALCULATION(S)—JOBS OVER$500.00 <br /> If above does not apply;follo�v guidelines below: <br /> 1. CONTRACT PRICE * is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> � 2-�"t�'��•� x.0125$ 5�.� <br /> (con�rac�price) (minimum$50.00) <br /> 2. STATE SCJRCHARGE <br /> �Z,5(�.� x.0005 $ � .Z,� <br /> (contract pricc) <br /> 3. POSTAGE&HANDLING(Only on Mait-1n Applications) $ 2.00 <br /> 4. TOTAL PER:�IIT I'EE(Add Lines 1-3 Above) $ �J' �•2.� <br /> ■ * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the <br /> permitted work including materials, labor,profit,and other fixed costs. It is the amount to be charged <br /> to the customer for the work done. If any material,equipment, la6or or installations are fumished by <br /> the owner, tenant or any other party,the reasonable market value of such items must be added to the <br /> estimated cost or contract price for permit fee purposes. In the evenE that there is a dispute on the <br /> amount of the job cost, the City may request the submission of a signed copy of the actual contract. <br /> MECHANICAL PERMIT-APPLICATION AGREEMENT <br /> The undersigned hereby applies to the City for issuance of a Mechanical Yermit, agrces to do all <br /> work in strict accordance with the ordinances of the City and the regulations of the State of <br /> Minnesota, and certifies that all statements made on this application are complete, true and <br /> correct. <br /> Applicant's Signature: Date: (�8 � 1 <br /> 3 <br />