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9529331869 22:23:36 01-09-2014 4/4 <br /> . . �► <br /> PERMIT FEE CALCULATION(S} ;' <br /> i BASED OFF-2002 STATE.STAT.UE` <br /> ❑ Yes,tt�is section applies <br /> The replacement of a Residential fixture or analiance that meets al!three of the foilowing requirements: <br /> I. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less; xc udin the cost of the fixture or appliance:and <br /> 3. Is improved,instaiied or replaced by the homeowner or(icensed contractor. <br /> Skip next sectioa,if this applies; Cost of Permit $ 1 . p <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Perrait Fee $ <br /> ' PERIVIIT FEE CAI.GULATI4N S -JbBS OVER$500:00 > ' ` <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> �f�'�'�' X.oi2s$ 5�>,����' <br /> (contract price) (mioimum$50.00) <br /> 2. STATE SURCHARGE <br /> �����'L' x.0005 $ ;�. v U <br /> (comracl price) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ �7�'�• d U <br /> ■ * COMRACT PRICE or JOB COST means the actual or estimated doIlar amount charged for the <br /> permitted work including materials,labor,profit,and other fixed cosEs. It is the amount to be charged <br /> to the customer for the work done. If any material,equipment,labor or installations are fumished by <br /> the owner,tenant or any other party,the reasonable market vatue 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 may request the submission of a signed copy of the actual contract. <br /> MECHA1vICAL• PERNIIT APPLIGATION 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 aze complete, true and <br /> correct. <br /> . . � �., <br /> , L! <br /> . ' <br /> Applicant's Signature�:�� � _�.- 1.:,.._— Daie: 1 ��I <br /> 3 <br />