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PERMIT�FEE CALCULATION(S) <br /> BASED OFF - ?002 S'I'ATE STATUE <br /> ❑ Yes,this sectio�l applies <br /> The replacement of a Residential fixture or appliance 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;excludin�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 Permit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-[n Fee(If Applicable) $ 2.00 <br /> TOt1:� Pt'CI?::t:CC � <br /> PERMIT FEE CALCULATION(S)-JOBS OVER $500 00 � <br /> [f above does not apply; follow guidelines below: <br /> 1. CONTRACT PRICE * is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> ���pD,DO X .oi2s $ �'�'. �n <br /> (contract pricc) (minimmn$50.00) <br /> 2. STATE SURCHARGE �/(� <br /> ` !D�� �U x .0005 $ , �� <br /> (contract price) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) � ,�Z, �]C; <br /> • * CONTRACT PRICE or JOB COST means the actual or estimated dollar 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. If any material, equipment, labor or installations are fur��ished by <br /> the owner, tenant or any other party, the reasonable market value of such items must be added to the <br /> f'.CtI1172.ta�{ COS? Q!' C^!?tC3Cr YCIC? fC." ��C::1lt fe� �,':; ^JSZS. �!: >�i.", ...:I.i iiiut iiiif� iS c. UiSj.:iii, vil i�iC <br /> amount of the job cost, the City may request the submission of a signed copy of the actual contract. <br /> MECHANICAL PERM[T 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 /> correct. Q <br /> C,�2 —�j4 3-2i7U <br /> A licant's Si�nature: �� • � � ���— ��i- <br /> PP , C2'"''l � ���V�� Date. � <br /> Reset Form <br /> 3 <br />