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, � <br /> �" °„� , "'�� "' "' ",; : ��PERIVIIT�'�FEE`'CALCT7L'ATION(S)_,., � ; ��, <br /> .�.�_�...,uW� _ <br /> � " � <br /> �' `" ,' ' °�BASED OFF--2002 STATE STATUE.` -� � f4 <br /> , � rb:. <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requirements: <br /> l. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excludine 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 Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> � �',�'�P„ERM1VIIrT�F.EE;�CAL;Ci7L�ATION S �::�JOBS'OVER�$�5p0�.Q0 <br /> �... <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE *is 125%of contract price with a(Minimum Fee of$50.00) <br /> c� U 6-t) x .0125$ <br /> (c tract price) (minimum$50.00) <br /> 2. STATE SURCHARGE <br /> x.0005 $ <br /> (contract price) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ <br /> • * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged 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 fumished 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 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 /> �'-�� ,.� �,NlEG '.'k: CAL'�PERIVIITuAPPI�ICATION�AGREEIVIE .r <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 are complete, true and <br /> correct. <br /> Applicant's Signature: �I�e���n � Date: � U O <br /> 3 <br />