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PERMIT FEE CALCULATION(S) <br /> BASED OFF -2002 STATE STATUE <br /> ❑ Yes,lhis section applies <br /> The replacement of a Residential fixture or apvliance that meets all three of the following requirements: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Has a total cost oY$500.00 or less;excludine the cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor. <br /> Skip next section,if this applies; Cost of Petmit $ 15.00 <br /> Staxe Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ _2.00 <br /> Total Permit Fee $ <br /> PERMTT FEE CALCULATION S —JOBS OVER$500.00 <br /> If above dces not apply;follow guidelines below: <br /> 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> 3D��.. ��� X.oi2s$ 7�.�c <br /> (contract price) (m io im u m$50.00) <br /> 2. STATE SURCHARGE <br /> �_ �oC�� ��� X.000s $ i, �� <br /> (contract price) <br /> 3. POS"I'AGE&F�ANDLING(Chily on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERNIIT FEE(Add Lines 1-3 Above) $ � 3 �� <br /> ■ * CONTRACT YRICE or JOB COST means the actual or estimated dollar amount charged for the <br /> pennitted work including materials, labor,profit,and other fised costs. It is the amount to be charged <br /> to the customer for the work done. If any material,equipment,labor or installations are fumished by <br /> the owner, tenant or any other party, the reasonable market value of such items must be added to the <br /> estimated cost or contract price far permit fee purposes. In the event 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 /> MECHANICAL PERMIT APPLICATION AGREEMENT <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all <br /> work in strict accordance with the ordinances of the City and the regulations of the State of <br /> Minnesota, and certifies that all statements made on this application are complete, true and <br /> conect. <br /> Applicant's Signature: �G-""� ��� Date: �—2Q�— / l <br /> Reset Form <br /> 3 <br />