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' 12-30-'16 13:34 FROM- T-629 P0003/0004 F-758 <br /> i `PERMIT FE.E CALctj A''JQN(g ,t ,, ; <br /> \ ' , '.BA'SFD QFF:�.2O,Q2 STA A.,$TAT .:��, , . <br /> [] Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requirements: <br /> I. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excluding 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 /> ,i ,;,• OE)0VIIT FEE'.CAL4.t;VA: ' QN(S),0OBS.`QVP,RilSQ0 00V, ' <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE a is 1.25%of contract price with a(Minimum Fee of$r5�0,00) <br /> /3835— x.0125$ /�7Z. LI <br /> (contract price) (minimum$50,00) <br /> 2. STATE SURCHARGE / 3 U V x.0005 $ l.L�3 qZ <br /> e <br /> (contract price) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ Wt <br /> 4, TOTAL PERMIT FEE(Add Lines 1-3 Above) $ n - 56, A �'t <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 furnished 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 /> NEt~HANICA;:PEI MIVA1400ATXO14;:A.GrRMO.I 7` . <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 /> 4///, <br /> Applicant's Signature: 4_ ,,,,, Date: 1 3 d [ <br /> 3 <br />