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. <br /> PB'RMT`T"F�E �ALCTILATI�N�Sj: <br /> � BA�BD OFF-2002 5T.ATE ST1�'TUE <br /> ❑ Yes,this section applies <br /> The replacement of a Residenrial fixture or liance that meets all three of the following requirements: <br /> 1. Does not require modification to elec 1 or gas service. <br /> 2. Has a total cost of$500.00 or less; excludin e cost of the fixture or appliance: and <br /> 3. Is unproved,installed or replaced by the homeo er or licensed contractor. <br /> Skip next secrion,if this applies; Cost of Permit $ 15.OQ <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicab $ 2.00 <br /> Total Permit Fee $ <br /> : , : PEx�IT F��c�,�u�.���o�tt��:`... 1o�s�����oa�fl � " <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> ' ��� � x.0125$ 5�� <br /> (contract price) (minimum$50.00) <br /> 2. STATE SURCHARGE **Add the State Bldg Code Div. Stucharge(Minimum Fee of$5.00) <br /> � � <br /> x.0005 $ `�, <br /> (contract price) (minimum$5.00) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> � � Od <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ � <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 ma.y request the submission of a signed copy of the actual contract. <br /> ■ **The STATE SURCHARGE is .0005 times the Contract Price or a minimum of$5.00. <br /> - f� �� ..1�iE�'� ' ' ��.L P�' -:' �:PPLi�C1�'TIO1�,��R���N!'''.,; �, � � <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 /> � g <br /> Applicant's Signature: � � Date: �'�dJ-' �� <br /> 3 <br />