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09/18/2013 WED 14: 29 FAX 763 473 8565 Sabre Plumbing & Heating QJ004/007 <br /> . • <br /> ❑ Yes,this section applies <br /> The replacement of a i2esidential fixture or apgliance tliat meets aIl three of the fotlowing requirements: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Has a to ]cost of$500.00 or Eess; xct in the cost of the fixture or appliance:and <br /> 3. Is improved,insta,lled or re�taced by the homeowner or licensed contractor. <br /> Skip next section,if this applies; Cost of Permit $ 15,00 <br /> State Surcbarge $ 5.00 <br /> Mait-In Fee(If Applicable) $ 2,00 <br /> Total Permit Fee $ <br /> If above does not apply;follow guidelines below: <br /> L CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> ���I�a.�o X.o�25$ �qq '7� <br /> (contract price) (minimum S50,00) <br /> 2. �TATE SURCHARGE I�q bO.00 x.0005 $ � �f q __ <br /> (contrnct price) <br /> 3. POSTAGB&HANDLING(Only on Mai(-In Applications) $ 2� <br /> 4. TOTAL PERMiT FEE(Add Lines 1-3 Above) $ Z�'� �� <br /> ■ " COIV'FRACT PRICE or JpB COST means the actual or estimated dollar amount charged fot the <br /> pern►itted work including materiats,labor,pro�t,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 fumished by <br /> the owner,tenant or any other party,the reasonable market value af such items must be addal to the <br /> estimated cost or contract price£or permit fee purposes. Tn 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 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 /> conect. <br /> Applicant's Signature: l� Date: 1- �g• �7,.O �1 <br /> 'I <br /> 3 <br />