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03-27-'17 10:42 FROM- T-959 P0003/0003 F-165 <br /> :PEWITTEE'C ILCULA'TION S " <br /> *)0. TA, ;STATVE <br /> ❑ <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 not Irequire modification to electrical or gas service. <br /> 2_ Has a tot it 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 /> . .:PBI MIT PEE;CALCULATION(S). JOBS OYER'$500;04; :;`::' . .. <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> l ( D x.0125$ U' ' <br /> (contract price (minimum$50.00) <br /> 2. STATE SIJRCHAROE )716 <br /> 7 x.0005 $ 0 o� <br /> (contract price) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ <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 fir 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 /> A/I <br /> ' CHANICAL;PEiiivi>:TA.EPIXCA'I'ZOg;A;GO$ NT.,:: <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 iy and the regulations of the State of <br /> Minnesota, and certifies that all statements • =de • his application are complete, true and <br /> correct. <br /> Applicant's Signat e: / <br /> Date: 7-17 <br /> 3 <br />