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11-11—'15 12:16 FROM— T-424 P0003/0010 F-760
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<br /> y r � , . , , � :°PERIy1TT F�E CAL�ULAT�O�(S) `, , fr�A cl�r, n ry,n ,
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<br /> �'i 4� r r� , y ",. :$A$��0��,-2UU.2 STAT��;STAT`IJE` °� ,, �� �c� ,, �a;
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<br /> ❑ Yes,this section applies ;
<br /> Thc rcplaccmcnt of R Rcsidcntial fixture or appiiancc that meets all three of the following requiremen[s: �
<br /> 1. Does n�require modification to electrical or gas service.
<br /> 2. �las a tocal cost of$SOO.OQ or less;excfudin�the cost of the fixture or appliance� and
<br /> 3. Is improved, installed or rep)aced by the homeawner or liceitscd contraetor. .
<br /> Skip next section,if this applies; Cost of Permit $ 15.00 -
<br /> State Surcharge � 5.00
<br /> Mail-In F�e(If Applic�ble) $ 2.00
<br /> Total Perm'tt�'ee $
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<br /> (f above docs not apply;follow guidelines belo�v:
<br /> !, COlV1��i?AC�'�'�XC� '� is 1,25%of contract price with a(Minimum Fee of$50.00)
<br /> � �'�—�•� ,x:oaz5�: � :�'� �, ;
<br /> (c�ntrapf prict)'. (fifnititu�r}55b.Q0
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<br /> 2. STAT�SUY2CHAl2GE � `�](',��"�� �j„ �`.ODUS :$' �� '
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<br /> `(con5�lCt price)' ;
<br /> 3. POSTAGE&HANDLING{Only on Mail-1n ApplicAtians) ;$'„�.,,,,"M,�,QOW�' "=�',_;,:
<br /> 4. TOTAL PERMIT FEE(Add Lincs 1-3 Abovc) $ ` 1 �`�
<br /> ■ � CONTRACT P1Z10E or JQB GOST mcans thc actual or estim3Ccd doll�r amount chargtd f'or Yhe
<br /> permitted wprk including matcrials,labor,protit,&nd other f xed costs. It i3 the amount to bC chArged
<br /> to thc customcr for thc work done. If any material,equi�iment, labor or ir�stzllations are furnished by
<br /> thc owner,renant or�ny othcr parry,the re�sonable market vatue of such items rnust be added to the
<br /> estimated cost.or contract price far permit fee purposos. In the cvcnt that the,�c is a disputc on the �
<br /> amount of the job cost, the City may request the submission of�Signcd copy of thc actual contraet. '
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<br /> �`,` ' '' ' ��lV1�C�'AI�YCA�,P�,1?1V1I'I'APP�TCA;PIQ�"A�REENIENT: ,, ., j s> , .. •s
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<br /> The undersigned hereby applies to the City for issuanee of a Mechat�ical permit, agi•ees to do all
<br /> Wark in strict accordance with the ordinances of the City and the regulations of the State of
<br /> Minnesota, and certifies that a(I statements made on this applicarion are complete, true and
<br /> carrect. �
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<br /> AppliCan�'S SignaiUre: `Date: '
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