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i <br /> - F.rom�COUNTRYSIDE HEATING & COOLING 763 479 2518 02/28/2013 15:59 #693 P.002/003 <br /> �PERMIT FEE CALCULATION�Sj. ; <br /> � � � ,�� _:- � _ :, <br /> ` �� �. �� - BASED OFP- 2002 ST;ATE STATUE� � <br /> ❑ Yes, this section applics <br /> The rep(acement of a Residential fixture or appliance that meets all three of the following requirements: <br /> ]. Does not require modi�cation to electrica] or gas service. <br /> 2. Has a t t cost of$500.00 or less; xcludine ihe cost of the fixture or appliance: and <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor. <br /> 5kip next section,if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> .. <br /> ��.:- .. .�-- .��'�R�1/ii�"`����A��i.J:L.��3L�J�1 �..�JOBS:D�,+',ER.,.$SUO::OA ..��;� .t} .�:;..?�... � <br /> If ab ve do s not apply; follow guidelines betow: <br /> � 1. CONTRA.CT PRICE *is 1.25% of contract price with a(Minimum Fee of$50.00 <br /> � �a <br /> '� �..5"'�0 0� �, .oi2s$ �J(, �' <br /> (concracc price) (minimum$50,00) <br /> 2. � STATE SURCHAItGE �� /� I • <br /> ���'-y„z��� x.0005 $ b • <br /> (conhact price) <br /> � 3. POSTAGE&HANDLING(Only on Mail-ln Applications) $ 2.00 <br /> I ^ . �� <br /> 4. '�TOTAL PERMIT FEE(Add Lines 1-3 Above) � <br /> ■ * CONITRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the <br /> p�erm�tted work including materials, labor,profit, and other fixed costs. It is the amount to be charged <br /> � tp the customer for[he work done. If any material, equipment, labor or installations are fumished by <br /> i + the owner, tenant or any other party, the reasonable market value of such items inust be added to the <br /> estimated cost or contract price for permit fee purposes. In the eveni 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 /> :; ` `' ' ....:�.`�!�E�:i�i.`I?�f3�!�i..'�'�12�I'�'1�PPL����I'I+QN"�.+Q���1'iT'�, x,,.::.. .. 'i:�..,...... <br /> ....a.,.:... <br /> 1 <br /> The undersigne� hereby applies to the City for issuance of a Mechanical Pennit�,agrees to do alI <br /> work in strict �ecordance with the ordinances of the City and the regulations of the State of <br /> Minnesota, and certifees thaY all statements made on this app2ication are complete, true and <br /> correct_ <br /> �� /��� � f� � <br /> Applicant's Signature: �` �" i?✓ Date: ��% �� <br /> � {��� ��1��`` <br /> � ' � 3 <br /> I <br /> ` � <br /> � <br />