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i <br /> � � ,�. �� : P�R'v1I"I FEI�CALCL)�L.h1�1 ION(S} � ' <br /> � � ��` �� B AS�,D 01=F' - 2�02 STATF �T:�`E'lIE <br /> ��. <br /> ,� <br /> �_ ❑ Yrs,this section applies <br /> The replacement of a Residenti3l tikture or appliance that meets all thrce of thc l�ollmm•in��rcquir�ments: <br /> 1. L7oes not require nioditicati�n to electrical or gas service. <br /> 2. Has a total cost of�+�00.00 or less excludino the cost of thc fixture or appliance:and <br /> i. l� impr����ed, installed or rep(aced b}�the homeol��ner or licenscd coou�actor. <br /> Skip ne�t section, if this applies: C:ost of Permit S I�.00 <br /> State Sur•char�_e S �.UO <br /> Mail-In Fce(If Applicablel S__ 3.00 <br /> Tot.al Permit Fee S <br /> � �PERME�T FEE CALCL1Lt�TION(S)�JOBS OVER �50f}.00__�_ _ � <br /> If above does i�ot a�pl}�;follo�c��uidelines belo���: <br /> I. ('OV'"I�R.a('1' PRICk� '< is I."?�°,o of contract price�ti�ith a(��linimum Fee of 5�0.00) <br /> � � `�* <br /> ` �jG.�C% � .oi�5� ��� 1 � <br /> __ ---_.. <br /> (coi tract��riczl (minimuru 5�0.00) <br /> ?. 5T,1TE SURCHARGF r/( rl C�c, �; � ./ <br /> 1 x .0005 5� <br /> —_____. <br /> (coi7tract pricc) <br /> �. POS�(��AGE K HANDLING (Only on\.tail-In Applications) � '�.00 <br /> 4. TOT:1l.P[:RM111T FEE(tldd l,ines I-3 .�bovel $ �` '���-- <br /> ■ � C'O\TRAC`T PR1CG or JC)6 CpS I� means the actua( or estimated doilar amount char�ed for tise <br /> permitted work includin� materials, labor. proht. and uther lixed costs. It is the amount ti� be charged <br /> � to the customcr for the���ork done. ]f ai�� materi�l, equipment. labor or instal(ations are furnished b�� <br /> the o���ner. tenant or any other pt�rty, the reasonahle market valuc of sueti items must be added �o tl�e <br /> estimated c<�st i�r contract price for permit fee purnc�ae�. In the event that thcre is a dispute on the <br /> amount of the job cost, t(�ie Cin ma�� request th� submission of 2 signcd copy of the �cxual cnntraeC. <br /> MECNANICAL f EKtiII"I'AI'PLICA"I,ION AGREEMEN'� <br /> ��l�he undersigned here(�y appli�s to thc Ciri� for issuance of a Mechanieal Permit, a�rees to do all <br /> �vork in strict accordance «it1� the orclinance; of tlle City and the re�ulations of thc State of <br /> Minnesc�ta, �u�d certifics that all statements made on this applicativn are cornpleCe, true and <br /> correct. <br /> n ^ � 1 ✓� <br /> /��',/� ( 1 I� i 3 <br /> A�pli�ant's Signature: ��.����-^�C./'� Date: <br /> Reset Form <br /> , <br /> J <br />