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� 12-14-2015 10:18 Fax 5ervices -�19522494616 �4 <br /> . ..__..._._._..._.._.. <br /> _ _ PERMIT FEE CALCULATIQN(S) _ __ <br /> BASED OFF-2002 STATE STA'TUE <br /> (�] Yes,this section applies <br /> The r�placement of a Residential ,fixturc�r appliance thac mects aU tbree of thc following requirements: <br /> 1. Does not require rnodificati�n to electrical or gas service. <br /> 2. Has a total cost of$5�0.00 or less;ex 1 'n the cost of the fixture or appliance:and <br /> 3. is improved,installed or replaced 6y the homeowner or licensed contractor. <br /> Skip next section,if this applies; Cost of Perrnit $ I5.00 <br /> State Sureharge $__ 1.00 <br /> M�il-In i'ee(If Applicable) $ 2:00 <br /> 'I'otal Permlt F'ee $ <br /> --- <br /> _� _ �_PERMIT FEE CALCULATION(S)—JOBS OVER$500.00 <br /> __.,_W___._._..___...._.._.._......................���.......�...�......�_........�J <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRAC'r PR]CE *is 1.25%of contract price with a(Minimum Fce ot'�$0.00) <br /> ..�k!/v• � x.0125$,...... .. <br /> (contract pdce} ���(minimum��50.0u) <br /> 2. STATF.SURCHARCE <br /> _x.UU05 $ <br /> __...,..: __. <br /> (contract price) <br /> 3. POSTAGB&HANDLING{Only on Mail-In Applications) �a_ 2.00 <br /> 4. TO'T'AL PERMIT FEE(Add Lines I-3 Above) $ �_� <br /> • " CONTAACT PRICE or JOB COS'I' means the actual or estimated dullar amount charged for the <br /> permitted work including materials, labor,profit,and other fixed costs, It is thc amoant to be charged <br /> to the cusfomer for the work done, If any material, equipment,labor or insta(lations arc lurnishcd by <br /> the owner, tenant or any other party, the reasonabic markct valuc of such items must be acidcd to the <br /> estimated cost or contract price for pennit fce 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 /> _..._.._.,._...�.,.. _ _ .. ... . ..... <br /> MECHAMCAL_PERMIT APPLICATION AGREEMENT <br /> .-----.._...�— - -----....,�.....�....._._.__..�.__,.._.._.,.._,.,..,...,...,,...,,,..� <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do al] <br /> work in strict accordance with the ordinances of the City and the regulations of the State of <br /> Minnesota, and certifies that all statcmcnts madc on this application are complete, true and <br /> correct. <br /> l � r . <br /> � , .. } <br /> Applicant's Sign�ture ���_�,.,) ___. ,_ Date: �� � I� � <br /> ,.�,,.... ----- ---- <br /> 3 <br />