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� �AY 14 '02 15�22 FR GENERAL DYNAMICS 952 921 6552 TO 99522494616 P.03/03 <br /> nOJ Iti VVYL Yy•JYY 11 W V111 YI VRW\V �iJVL4itYlY 1 LJY I .YYJlYYJ 1 141 <br /> PERMYT �?'EE CALCIJLATIONfSI <br /> 2�02 State S�atvte �Y'es, This Sectioa Applfies <br /> The replacement of a Re�idential fvcn�re oc ap�lian__ _�r, that meets all three of the follo�cving <br /> requi�remeau: <br /> 1) Does �require modificauoa to electrical or gas service. <br /> 2) YYas a co of$500.00 or less; .ex�' the cost of the fixiure or appliance: <br /> ar►d. <br /> 3) Ys improved., iastalled or Ieplaced by rh�e homeowner or licenced con�actor. <br /> Sl�ap next secrioa; Cost of Permit $ _ 15.00 _ <br /> State Surcharge $ - -SO <br /> Mail In Fee $ _ �.SO <br /> Tf above does not apply, follow guidelines below: <br /> 1. Coatract Price* is .0125 % of job 'with a Minimuxn Fee of(�35.001 <br /> �/� x .0125 $ �s, vo <br /> fcouuacz pri�ce) (miairaum 335.00) <br /> 2. �tate�utchar�e. �� Add the Swte Buildin� Code Division a (M�niumwn Fee of$ .50) <br /> %�D� x .0005 $ ��� <br /> ...........�.._ <br /> (conaact Price) (miaimvm$ .SO) <br /> 3. �ostae�an8 As»dling (Oaly mail-in applications) $ _ i_so_ <br /> 4. TOTAL pERNIIT FF.E (Add lines 1-3 above) $ �3s� s'�' <br /> * CON'IRAC?PRI�E or JOB COST meat►s che accual or estima�d dolJat a:aoua�ch�vged.for che petmicoed <br /> work iacludiag maurials.labor,proFi�,and other fized costs. I�is rl�e amouat�o be chazged to�he cvswmer <br /> �'or�hc work doae. If an�►ma[erial, equiprueAt�labor.or iaS�alladoa are turnisbed by th�ownet,u�naac or <br /> say ocheT parry�he reasouablc marlaec value of such i[ems must be added to the esiimated coss or coaaact <br /> price fur permit fee purposes. bn tbe eveat�at chere is a dispute aa the amowu of�he job cos�,the Ciry u�ay <br /> requesc�►e submissioA of a si�ned copy oF ehe ac�ual coaRac�. <br /> +# Tbe STATE SURCHARGB is.0005 of the co�u�acc price under$1.�0,000 or $.50-wluchever is greater. <br /> For valus�ioas ovcr$1►000.000 caU the Depar�meai of Inspectiou Services fos�he pri�ce. <br /> The undersigned hereby applies to rhe City far iss�►a� of a Plumbiag Perauit, agrees to do all <br /> work in s�ict accordence with the ordinaflce� of the City and the regulauons of che Sca=e of <br /> Mi�esota. and cettifies that ali statemeats mad,e on this application are complcce, nve aad <br /> COtICCL. <br /> Applicaiu's Signature: i��}� - _.. Date: �—/�-aa <br />