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t • PERMIT FEE CALCULATION(S) � BAS��I�) OFti� - 2042 STA"lE S'TA"I'LTI? ❑ Yes,thi�section applies The replacement of a Residential fisture or appliance that meets all three of the following requirements: L Does not require modification to electrical or gas service. 2. Has a total cost of$500.00 or less;excludin�the cost of the fixture or appliance: and 3. Is irnproved,installed or replaced by the homeowner or licensed contractor. Skip next section,if this applies; Cost of Permit $ 15.00 State Surcharge $ 5.00 Mail-In Fee (If Applicable) $ 2.00 Total Permit Fee � pr-.�T r��F c�1,ct�,AT1oN s -Jo�s ovEx�soa.00 If above does not apply; i�,11o�n guidelines bclow: 1. CONTRACT PRICE " is 1.25%of contract price with a(Minimum Fee of$50.00) ZR'�oa X .0125 $ �� (contract price) (minimum$50.00) 2. STATE SURCHARGE -� `Z`��D,�4 X.000s � C,�S (contract price) 3. YOST�GE&I IEINDLINU(Only on Mail-In Applications) $ 2.00 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ �i L��J • * CONTRACT PWCF: or JOB COST means the actual or estimated dollar amount charged for the permitted work including materials, labor,profit, and other fixed costs. It is the amount to be charged to the customer for the work done. If any material, equipmenl, labor or installations are fumished by the owner, tenant ur any other party, the reasonable market value of such items must be added to the estimated cost or contract price for permit fee put�ses. In the event that there is a dispute on the amount oY the job cost, the City may request the submission of a signed copy of the actual contract. MECHArIICAL PERMIT APPLICATION AGREEMENT The undersigned hereby applies to the City for issuance of a Mechanical Pennit, agrees to do all work in strict accordance with the ordinances of the City and the regulations of the State of Minnesota, and certifies that all statements made on this application are complete, true and correct. Applicant's Signature: �� Date: ��'g�� Reset Form 3