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. <br /> – -- <br /> --_ _. ___—___ ___ <br /> PERMIT�'LC CAC,CULATION{S). ' � � �� � <br /> __ � � � BAS�D �fiP -2002 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 modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less; excluding 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-in Fee(If Applicabie) $ 2.00 <br /> Total Fer���it Fee $ <br /> .as�,�;s.���������=�` : � � �'"�������. , ���.�.� � <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 /> D c . � X .o�zs� � �:S,�C� <br /> (contract price) (minimum$50.00) <br /> 2. STATE SURCHARGE I'� � � /� <br /> V' x.0005 $ � "•�U' <br /> ( ontract price) <br /> 3. POSTAGE&HANDLiNG(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ I J� ��� <br /> ■ * CON"fRACT PRICE or JOB COS'l means the actual or estimated dollar amount chargea 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 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 pw-poses. In the event that there is a dispute on tl�e <br /> amount of the job cost, the City may request the submission of a signed copy of the actual contract. <br /> "" .���,:.� <br /> Ca W ;f������� '':''.,�� ,�' �.a�.'.� "t" 'Fk.c*�+�.9a>�'��, <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 Ciry and the regulations of the State of <br /> Minnesota, and certifies that all statements made on this application are complete, true and <br /> correct. <br /> Applicant's Signature: Date: �� �i r I <br /> 3 <br />