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9529331869 13:56:06 02-02-2015 4/4 . . PERMIT EEE CALCUL`ATION(S) ; ;BASED OFF-2002 STATE STATUE i . ❑ Yes,this section applies The replacement of a Residential fixture or appliance that meets all three of the following requirements: 1. Does n requue 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 tliis applies; Cost of Penmit $ 15.00 State Surcharge $ 5.00 Mail-In Fee(If Applicable) $ 2.00 Total Permit Fee $ PERMIT'FEE CALCULATION S =yOBS'OVER$500.00 If above does not apply;follow guidelines below: 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00) � 30,000 x.oi2s$ '��5.C� (contraCt pricc) (minimum$50.00) 2. STATE SURCHARC�E �3gc�00 X.000s $ t5.0� ��o��Pri�� 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ 3 10.� ■ * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for d�e permitted work including materials,labor,profit,and other fixed cosEs. It is the amount to be chazged 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 rnust be added to the estimated cost or contract price for permit fee purposes. In the event thai there is a dispute on the amount of ihe job cost, die City may request the submission of a signed copy of the actual contract. 1VIECHANICAI;•PERIvIIT APPLYCATION.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 the City and the regulations of the Siate of Minnesota, and certifies that all statements rnade on this application are complete, true and correct. Applicant's Signature: ��2G�-�� Date: OZ ZOtS 3