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07/25/2017 TUE 8: 07 FAx 763 473 8565 Sabre Heating & Air Cond 2007/007 <br /> EfE< I lil'I+Fi (' \i c n P\fmf(lf(-61 <br /> [1 Yes,this section applies <br /> The replacement of a Residential fixture;of apoltioige that meets all three of the following requirements'. <br /> 1. Poes 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 Perna $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2 00 <br /> Total Permit Fee _ <br /> E v u � ��',..�gr.!' ,<R',+ c ti c ` � \F f()i�i. L. I'( !�l�j -/l • <br /> ,... .t. <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICY *is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> I��a�•00 x.0125$,^ <br /> (contract price) (minimum$50.00) <br /> 2, STATE SURCHARGE <br /> 16 ).0.CC ,x.0005 $ tij c <br /> (contract price) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTALPriIiMfl W1 (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 /> '",r• t f \t llf tr IdE T ,i[I P.�, ,!�C ,� Tt�c Si1Y� ,1STE - 9/h {.F_ <br /> me 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 /> Applicant's Signature: d., A . Date' •1.5•Z.O/7 <br /> 3 <br />