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From:COUNTRYSIDE HEATING & COOLING 763 479 2518 08/13/2012 11 :44 #572 P.003/003 <br /> . , , <br /> ., .. , . <br /> � .: � �ERMIT�FEE CALCULAT�ON{�) ��= �-,- � �= � �:: ' <br /> BASED OFF-2002 STATE STATUE <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or a�pliance 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 of$500,00 or less;excludinQ the cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor. <br /> Skip next scction,if this applies; Cost of Permit $ 15_00 <br /> State Suzcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee S <br /> .... . 9:�.F. ..,.....:.. ....��.�... . ..�.���:"1�,�,�alr.i77:�+Yx���,1.^.1 �� ::?'.��17�.�V�F'��.Y�.k�D .�...;,#X �,�..,h�)!4 s,..n�,u <br /> If above does not apply;fo(low guidelines below: <br /> 1. CONTRACT PRICE *is l.25%of contract price with a(Minimum Fee of 550.00) <br /> 600D. � X .o�2s$ �3' 0� <br /> (con�act price) (minlmum 550.00) <br /> 2. STATE SURCFiARGE <br /> 6 0 00 _ oo _x.0005 $ ,� <br /> (contract price) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2�0 ____! <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ / $ , 0� <br /> ■ * CONTRACT PRIC� or JOB COST means the actual or estimated dol[ar amount charged for the <br /> permitted work including materials,labor, profit, and other fixed costs. It is the amount to be charged <br /> to the customer for the work done. Tf any material, equipment, labor or installations aze furnished by <br /> thc owner, tcnant or any other party, the reasonable market value of such items must be added to the <br /> estimated cost or contract price for permit fee purposes. In the event that there is a dispute on the <br /> amounc of the job cost, the City may request the submission of a signed copy of the actual contract. <br /> , �C�I�IC�I�,�P�IZ��'�'�-����,.�`r��`$'�4I!�,�'+.��`r�Ei1+�E.N�`_ ' .� ��:.� � . <br /> 5 <br /> -ti_�,4'.. , itM'}S9 h na'Fi <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 certifes that all statements made on this application are complete, true and <br /> correct. <br /> Applicant's Signature: )� ✓ Date: � ��'�J ' �� <br /> �63 .y�g , troo <br /> `Reset Fotr�i � <br /> ,..,,-..... . . ...- ,..,r.��.( <br /> 3 <br />