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9529331869 17-57:32 06-05-2014 4/4 <br /> ' PERMIT EEE CALCULATION(S) <br /> ` BASED OFF-2002 STATE STATUE <br /> ❑ Ycs,tl�is section applies <br /> The replacement of a Residential lixture or appliance that meets all tlu'ee of tl�e following requirements: <br /> 1. Does not require moditication to electric�l or gas service. <br /> 2. I�as a total cost of$500.00 or less;excludina the cost of the fixn�re or appliance:and <br /> 3. Is impruved,installed or replaced by the liomeowner or licensed contractor. <br /> Skip next section,if this appties; Cost of Perniit � t 5.00 <br /> State Surcharge � 5.00 <br /> Mai]-In Fee(If Applicable) $ 2.00 <br /> TotuE Permet Fee $ <br /> PERMIT FEE"CALCULATION S —JOBS`OVER'�500:00 <br /> If above does noE app(y;follow guideli�ies belo�v_ <br /> 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$SQ.OU) <br /> �� 5 a <br /> �,�OCC� ..ol2s� <br /> (contract pricc) (minimum 550.00) <br /> 2. STATE SURCHARGE ,,n <br /> ;.�f�C°�,i x.0005 � I, �U <br /> (contract pricc) <br /> 3. POSTAGE&HANDLING(Oniy on Mnil-In Applications) $ 2.00 <br /> �;� uU <br /> 4. TOTAL PERMIT FEE(Add Lines i-3 Above) $ <br /> ■ * CON"T'I2ACT PRICE or JOB COST means tiie �ctual or es�imated dollar amount charged f'or the <br /> permitted work incittding materials,11bor,profit,and other tixed cosis. It is U�e amount to bc cliargect <br /> to Uie customer for tlte work done. If any material,equipment, labor or inst�llations are hirnished by <br /> the awmer, tenant or any otlier party, tlae re�sonable mnrket value of such items must be added to the <br /> estimated cost or cotttracl price for peimit fee purposes. In the event tl�at there is a dispute on the <br /> amoimt of the job cost, the City m1y rec�uest the submission of a siened copy of tlie actual contract. <br /> Iv1ECHANTCAL PERIVIIT APPLICATION AGREEMENT , <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do aii <br /> work in strict accordance with che ordinances of die City and the regulations of the State of <br /> Minnesotu, and certifies that all staiements made on this application are complete, true and <br /> concct. <br /> A licant's Si natur � `J�ti u �� -tiv:)�.--�L��--- f�? �-, � <br /> pP g �_ -T C � � ��Gt, Date: <br /> 3 <br />