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02-13—' 18 08:00 FROM— 1-520 P0003/0004 F-959 PERMIT FEE CALCULATIONS) BASED OFF.-2002 STATE STATUE ❑ Yes,this section applies The replacement of a Residential fixture or appliance that meets all three of the following requirements: I. Does not require modification to electrical or gas service. 2. Has a total cost of$500.00 or less;excluding the cost of the fixture or appliance:and 3. Is improved,installed or replaced by the homeowner or licensed contractor. Skip next section,if this applies; Cost of Permit $ 15.00 State Surcharge $ 5.00 Mail-In Fee(If Applicable) $ 2.00 Total Permit Fee $ PERMIT FEE CALCULATIONS) JOBS OVER$500.00 If above does not apply;follow guidelines below: 1. CONTRACT PRICt is 1.25%of contract price with a(Minimum Fee of$50.00) )ttql0 :010 , ktnyiAkid *.i,11-0#01.9:9,9))i 2. STATE SURCHARGE 13 2LW0 40 $ i . 3. POSTAGE&HANDLING(Only on Mail-In Applications) ($� 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) ■ * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted work including materials,labor,profit,and other fixed costs. It is the amount to be charged to the customer for the work done. If any material, equipment, labor or installations are furnished by the owner,tenant or any other party, the reasonable market value of such items must be added to the estimated cost or contract price for permit fee purposes. In the event that there is a dispute on the amount of the job cost, the City may request the submission of a signed copy of the actual contract. MECHANICAL PERMIT APPLICATION AGREEMENT The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all work in strict accordance with the ordinances of a City and the regulations of the State of 'Minnesota, and certifie hat 1 statem;,: m. •n this application are complete, true and correct. Applicant's Signature: r' �s:�l�u /!, l`•7-�'� !' > ate, 3