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10-17—'17 14:02 FROM— T-972 P0006/0007 F-347 <br /> PERMIT FEE CALCULATION'($) <br /> BASED OFF-2002 STATE STATUE <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requirements: <br /> 1. Does net 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 Pee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> PERMIT FEE CALCULATION(S)'—JOBS.OVER$500.00 <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE is 1.25%of contract price with a(Minimum Fee of$50.0U)� <br /> 11Xt V 6i.025 <br /> ntraG�rice� 6i 025 �mumQ$s 50. <br /> 0p <br /> ~) <br /> (t*Api <br /> 2. STATE SURCHARGE <br /> ,,rci0. <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) ($) W `m' j <br /> 4. TQTAI.PERMIT FEE(Add Lines 1-3 Above) <br /> 77 <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 /> MECHANICAL PERMIT APPLICATION AOREEMENT <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 .ty and the regulations of the State of <br /> Minnesota, and certifies that all statements made t.his application are complete, true and <br /> correct. <br /> Applicant's Signature: / � 7 <br /> �ate:� <br /> 3 <br />