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s <br /> w <br /> PER:'�IIT FEE CALCULATION(S) <br /> 2002 State Statute ❑ Yes This Section Applies <br /> The replacement of a Residential fiYture or appliance that meets all three of the following req�iirements: <br /> 1) Does not require modification to electrical or gas service. <br /> 2) Has a total cost of$500.00 or less; escludinQ the cost of the fi:cture or appliance: <br /> and <br /> 3) Is improved, installed or replaced by the homeo�vner or licensed contractor. <br /> Skip next section; Cost of Permit $ 15.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee $ 1.50 <br /> If above does not apply, follow guidelines below: <br /> 1. Contract Price* is .0125% of job with a vlinimum Fee of(�35.00) <br /> �0"�5�, Y .ol2s $ �`1�i,�-I� <br /> (contract price) (minimum$3�.00) <br /> 2. State Surcharae. ** Add the State Building Code Division a Minimum Fee of($ .50) <br /> �n3��� Y .0005 $ '� ,�g <br /> (contract price) (minimum�.�0) <br /> 3. Postaae and Handlin�(Only mai[-in npplications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �{`��p� <br /> *CONTR�CT PRICE or JOB COST means the actua]or estimated dollar amount charged for the permitted work including <br /> materials,labor,profit,and other fixed costs. It is the amount to be charged to the customer for the work done. If any material, <br /> equipmen� (abor,or installation is furnished by the o���ner,tenant or any other party the reasonable market value of such items <br /> must be added to the estimated cost or contract price for permit fee purposes. In the event that there is a dispute on the amount of <br /> the job cost,the City may request the submission of a si2ned copy of the actual contract. <br /> **The ST�TE SURCHARGE is.000�of the contract price under$1,00Q000 or$.�0-whichever is greater.For valuations over <br /> $1,000,000 ca(i the Department of Inspectional Services for the price. <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit,agrees to do ail�cork in strict accordance with <br /> the ordinances of the City and the regulations of the�finnesota S[ate Building Code,and certifies that all statements made on this <br /> application are complete,true and correct. <br /> Applicant's Sib ature: Ti�/!�� ,�:�Q.�z�¢,�-zCz�. Date: �'�'� <br /> Approved By: Date: <br /> 3 <br />