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9529331869 13:57:13 08-06-2014 4/7 <br /> PERMIT FEE CALCULATION(S) <br /> l,•BASED OFF-2002 STATE STATtTE ; • <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or aaaliance that meets all three of the following requirements: <br /> 1. Does not require modifccation to electrical or gas service. <br /> 2. Has a total cost of�500.00 or less;excludina the cost of the fixture or appliance:and <br /> 3. Is improved,instalied or replaced by the homeowner or licensed contractor. <br /> Skip next section,if tliis 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.ERMIT FEE CALCULATION S --JOBS'OVER I$SQ0:00 <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> �l`�l,U.l):� x.0125$ %>1 .2,..7 <br /> (contmct price) �(minimum$90.00) <br /> 2. STATE SURCEIARGE _ <br /> �`�l,t>.Ul.i x.0005 $ f.Z 5 <br /> (contract price) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FGE(Add Lines 1-3 Above) $ ,�� .Z`"J <br /> • * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the <br /> permitted�vork including materiais,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, tabor 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 /> esKimated cost or contract price for permit fee purposes. In the event that there is a dispute on the <br /> amount of tlie job cost, the City may request the submission of a signed copy of the actual contract. <br /> Iv1ECHAIJICAL PERIVIIT APPLTCATION;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 are complete, true and <br /> correct. <br /> Applicant's Signature: ' )�( ;�,�h) �d:��/ Date: ,�/(.y��� <br /> 3 <br />