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PE�21�I�'��E C�:�,��JLt�'�'IOIlilS� <br /> 20Q2 Sta#e �ta.tute ❑ Yes, 'Fhis �ection .�pplies <br /> The replacemen# of a Residentiat 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 licenced contractor. <br /> Skip next section; Cost of Permit $ 15.00 <br /> State Surcharge $ .50 <br /> Mail In Fee $ 1.50 <br /> If above does not apply, follow guidelines below: <br /> 1. Contract Price* is .0125 °rb of job with a l�linimum Fee of (�35.Od� <br /> ��Da.00 x .0125 $ <br /> contract price) (minimum$35.00) <br /> 2. State Surcharge. ** Add the State Building Code Division a (Minimutn Fee of$ .5Q) <br /> x .0005 $ <br /> (contract price) (minimum$.50) <br /> 3. Pdstage and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. '['Q�'AL PERIV�IT FEE (Add lines 1-3 above) � <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amounY charged for the permitted work <br /> inciuding materiais, labor, profii, and other fixed costs. It is the amount to be char�ed to the customer for the work <br /> done. If any material, equipment, labor, or installation are furnished by the owner, tenant or any other party the <br /> reasonable market value of such items must be added to the estimated cost or contract price For permit iee <br /> purposes. ln the event that there is a dispute on the amount of the job cost, the City may request the submission <br /> of a signed copy of the actual contract. <br /> ** The STATE SURCHARGE is .0005 of the contract price under $1,000,000 or $.50-whichever is greater. <br /> For vatuations over$I,000,000 call the Department of Inspection Services For the price. <br /> The undersigned hereby applies to th ity for issuance of a Plumbing Permit, agrees to do all work <br /> in strict accordance with the ordina of the City and the regulations of the State of Minnesota, and <br /> certifies that all statements made o , t�cati n re comptete, true and correct. <br /> �--- y <br /> Applicant's Signature: � Date: ��Y� <br /> ,. .. . .. <br /> E�es�fi Form <br />