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Nor-;7-2002 02:16p� Fro�-CITY OF OR�10 +9522494616 T-g4� P.003/003 F-368 <br /> P�RMYT FEE CA N <br /> 200�state Ststnte Q Yea T6is sectivu Applies <br /> 'Y'he replace�nent of a�2esidenttal . or '�,�that meets elI three of the fallavving requiremen�s: <br /> 1) l�s nat require mod�cation to electrical or gas servico. � <br /> " 2) Has a tamt cose af�500.00 or lcss;�g the cost of the fixture or appliance: <br /> and <br /> 3) Is unptoved,instalted or replac�d by the homeowner or liccnsed contractor. <br /> Skip next sectia�; Cos�of Ps�rz $_ 15.40 <br /> State Siu+cbarge � . <br /> �_ .50 <br /> Mail-Iu Fce $ �"` <br /> ..�,�_ <br /> If abovc dces not apply,fottow guideliues below: <br /> X. CQntract Pricei is.01as°io of�ob wi�a ' ' um F S <br /> �(�o�Ov x.0125 $ ���� <br /> (conaacc price) (minimua+S3s.00) <br /> 2.�tate Surchar�e�*�Add the St$te$uilding G�de Division a Mia mi nm�'ee o�(��gpj. <br /> 6$0� X.000s � 3,`t � <br /> (eont�s,ct price) (minimiat�S.SO) <br /> 3.pQ,�pe aa �S(4n1y n,ail-f»applicafio�.$) � ,�� _ <br /> 4.TOrAL FERIVII'.f�E(Add lines 1-3 above) � ,� q �9� <br /> *COIVTRACT PRiCE o�70B COST mqng chc actua!or rstimated dp11Ar smo�snr cha�ed for iha pe�mitud work lnctuding. <br /> materials,labor,profit,and otder fixtd oosts.tt is rhe amotmt co be charged co tde a�stamee fot�he work�one.If aay rnsarisl� <br /> cquipaten�,labor,or installatioa is flunished by thz cwnet,ttaant or any ocber party rhe nusonabie aaaxl.ret value cf sush ioc:ns <br /> must be adde4 to ihe estirnated oost or aunAact prica for ptrmit fee purposts.In tt�e evtnt that rhere is a dispute on the a�naum of <br /> �.1��.�e City�y loques[tht submission of a si�ed copy oPthe aceual eontr�t. <br /> •+Tht STATE Sif�CH,qRGE i�.Q005 of tbe conttact price unda S1,0�0,p00 or 5.56•whichrv�is grtaxa Por vtluations ov� <br /> S 1,Q00.000 calt the Dept�rrtmtnt of L�spec�io�s�Servtces for thn peice. <br /> 't1�undersigietd l�+edy applies to tha Ciry Por isauana of a Mcchenical Pamit,s�ee ta do all wotk in snfet aecord�ce with <br /> d�t ordinsaces ef the Cicy slnd nc�rcgutations of rhe Minnesata State�uiiding Code,and eatifies that a1!statemeats macie oa this <br /> aPPUcation a�+e oompletr,orae snd con+ect. <br /> Applicant's Sigilature• p�. �Z 3l p 7� <br /> Apgraved By: ,,, �,_ �: <br /> 3 <br />