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. <br /> . <br /> PERMIT FEE CALCtTLATION(S) <br /> BASED OFF- ?00? STATE STATUE <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requirements: <br /> 1. Does not require modif�ication to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excludine the cost of the fi�cture or appliance: and <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor. <br /> Skip ne�ct section,if this applies; Cost of Perniit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Tot:il Permit Fee $ <br /> PERMIT FEE CALCULATION(S)—JOBS OVER $500.00 <br /> If above dces not apply,follow guidelines below: <br /> l. CONTRACT PRICE *is 125%of contract price with a(Minimum Fee of$5U.00) <br /> ����,`� ,OD x.0125$ � 1�•rJ�P <br /> {contract price) (minimum$50.00) <br /> 2. STATE SURCHARGE <br /> � �C�5��� X.000s $ �.�1 l� <br /> (contract price) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ ��lF.L,2, <br /> ■ * CONTRACT PRICE or JOB COST means the actual or estunated doilar amount charged for the <br /> permitted work including materials,labor,profit, and ott�er fixed costs. It is the amount to be charged <br /> to the customer for the work done. If any matenal,equipment, labor or installations are furnished 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 for permit fee purposes. In the event that there is a dispute on the <br /> amount of the job cost, the City tnay request the submission of a signed capy of the actual contract. <br /> MECHAIVICAL PERMIT APPLIC�TION 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 alI statements made on this application are complete, true and <br /> correct. <br /> Applicant's Signature: ' Date: �7" ��� ' / f <br /> � <br /> Reset Form <br /> 3 <br />