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� PERMIT FEE CALCULATION(S) �� BASED OFF -2002 STATE STATUE ❑ Yes,this section applies The replacement of a Residential firture or appliance that meets all three of the following requirements: 1. Does not require modification to electrical or gas service. 2. Has a total cost of$500.00 or less;eYcludine the cost of the fisture or appliance: and 3. Is improved,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 $ PERMIT FEE CALCULATION(S -JOBS OVER$500.00 If above does not apply;follow guidelines below: 1. CONTR4CT PRICE * is 1.2�%of contract price with a(Minimum Fee of��0.00) ��'��d i QV x .0125 $ �i (conrract price) (minimum Sa .00) 2. STATE StiRCH.4RGE ��OD�av X .000s � o� 07� (conVact price) 3. POSTAGE&HANDLING (Only on Mail-In Applications) $ 2.00 4. TOTAL PERII�IIT FEE(Add Lines 1-3 Above) $ �p� � �u ■ * CONTRACT PRICE or JOB COST means the actual or estimated doilar amount chartred for the permitted work includine materials, labor,profit, and other fixed costs. It is the amount to be charQed to the customer for the work done. If any material, equipment, labor or instailations are furnished by the owner, tenant or any other party, the reasonable market value of such items 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 the job cost, tne City may request the submission oi a signed cupy of the actual contract. MECHANICAL PERMIT APPLICATION AGREEMENT The undersi�ned hereby applies to the City for issuance of a Mechanical Permit, 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 Signat e• Date: O� pT�l Reset Form 3