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{ <br /> 701.`• 1+.4441,11 PERMIT FEE CAT 41 (OA' <br /> x =BASED OFF -2002 STA 'E�; ,; <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 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 $ .50 <br /> Mail-In Fee(If Applicable) $ 1.50 <br /> Total Permit Fee $ <br /> t: :,,; s _.` l SERI V:F.E500.01 A 1`I J (81W01 KOYER15 0'00 ``;„Z <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee off$$35.00) <br /> 2,000 x.0125$ , 00 <br /> (contract price) (minimum$35.00) <br /> 2. STATE SURCHARGE **Add the State(Bldg Code Div.Surcharge(Minimum Fee of$.50) <br /> V x.0005 $ / V <br /> (contract price) (minimum$ .50) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 1.50 <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 may request the submission of a signed copy of the actual contract. <br /> • **The STATE SURCHARGE is.0005 of the Building Department at(952)249-4600 for the price. <br /> :=_ :-WC I TI0 ?ERaTIM =TCATION 700t7MEll i:4: 0.4Y <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 /> 9qApplicant's Signature: AA i! '_ _� li1l.� Date: 3c2 — <br /> 4 �arFyrAz � kf;.�..� '� 21557 <br /> Reset Form 1 , <br /> 3 <br />