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10-31—'17 15:36 FROM— T-069 P0003/0004 F-454 <br /> PEk2Ivi1TFEE CALCULATION(S) <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 requirein nts. <br /> 1. 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 Pee $ <br /> PERMIT FEE CALCULATION(S)—JOBS OVER$500.00 • <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE *is L25%of contract price with a(Minimum Fee of$50.00) <br /> 452 <br /> Kcdn@�t.FSl�Fy minimum sa�) <br /> 2. STATE SURCHARGE .55Z2 <br /> (pg <br /> x00005 <br /> ((cgntt c.i#190) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) @ Ml6Ni r,._....� <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ r <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-ob cosl he-Gi _a uestthe-submission-ofa si ed-co of the actual-contract. <br /> MECHANICAL PERMIT APPLICATION 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 o . - application are complete, true and <br /> correct. <br /> / / ; <br /> Applicant's Signature: / @atei) /Q -3I-17 <br /> Ir <br /> 3 <br />