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12-18—'15 15:50 FR4M— T-501 P0003/4004 F-861 <br /> � � • _ <br /> . . PERMIT FEE CALCULA,'�`TON(S) - <br /> BASED OFF-2002 STA'T�STATUE : <br /> [] �'es,this section applies <br /> G <br /> The replacement of a Residentisl fixturo or an lp IanCe that meets ail three of the fotlowing requiremcnts: f <br /> 1. Does n require modification to electrical or gas service. <br /> � <br /> 2. Has a total cost of$500.00 or less;excludin�the eost of the fixture or appliance:and <br /> 3. Ys improved,installed or replaeed by the homzo'wntr or licen3ed contractor. � <br /> �. <br /> Skip next section,if this applics; Cost of Permit � I5.00 <br /> State Surcharge $ 5.00 � <br /> Mail-Cn F�(rf Applicable) $ ?.00 - <br /> Total Pern�➢t Fee $ <br /> PEFtMIT F�3�CALCULATION S —JOBS OVER$SOdAp � <br /> If above does not apply;follow guidelines below: ; <br /> l. CONTRACT PRIC� *is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> �� ��-�'���;012.5$`;< . f <br /> �:,.i}._�t�,r!ce � � . !iiil�ldioiril'fS0.U0`, i <br /> 2. STAT�SC112C�TARG� (� � <br />� � "lq� ���� ,c�qoos';:$� , <br /> Ccoi�@acc..jp'ic� .. .. . <br /> 3. POSTAGE&HANDL�NCr(Only on Mail-In Applicacions) �$J �2:UQ';:�� <br /> --�-.----....._ <br /> 4. TOTAL PERMM'��L��(AddLines i-3 Above) $:',�;;;,�:i,'� ��,.;:.'���.�.. �.:� <br /> �. ......_.._ <br /> ■ * CONTRACT PRICE or J'OB COST rneans the actual or estimated dollar amoun{charged for the i <br /> pern,itted wark inc[uding materials,labor,profit,and other fixed costs. It is the amount to be charged <br /> to she customer for the work done. Tf any material,equipment, labor or installations are furnishr.d by ' <br /> the owner,tenant or any other party,the reasonable mazket value of such items must be added to the <br /> estimated cost or contract price for permit fee purposcs. In the event that thcrc is a dispute on the <br /> amount of the job cast,the City may request the submission of a s'rgned eopy of the actual eontraet. ; <br /> � <br /> MECHAN'YCAL PBRMIT APPLICATIOI�ACrREEMEN7'. � <br /> The undersigned hereb� applies to the City for issuance of a Mechanical F'ermit, agrees to do all j <br /> work in strict accordance with the ordinances of the City and the regulations of the State of � <br /> Minnesota, and ceitifies that all statements made on Chis application are complete, true and � <br /> cor�ect. <br /> i � <br /> Applicant's Signature: ���'v ��dY� fDa,te:) I �I � � I � <br /> t..:........ , <br /> 3 <br /> � <br /> � <br />