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O6/09/2015 TUE 8: 52 FAx 763 473 8565 Sabre Heeting & Air Cond f�004/007 <br /> � 4 <br /> R. <br /> ❑ Yes,th�s section applies <br /> The replacement of a Residontial_fixturo or annliance thut rraeats�ll thrae of the follaw�ng�requirements: <br /> 1. 17oes.ztoi require�nodi fication t�electrical or gas service, <br /> 2. Has a total casl of$500.00 or less; 1 n the cost of the fixture or eppliat�ce:and <br /> 3. Is improved,installed or replaced by the homeowner or licen9ed c�ntra,ctor. <br /> Skip next section,ifthis applies; Cost oPPennit � 00 <br /> Stato Surcharge $ 5,Q0 <br /> Mail-In Fee(Tf Applicable) $ ��oo <br /> , TotRl Permit l�ee $ <br /> t � <br /> If above does not apply;£allow guidelines balow� <br /> ]. C '" is 1.25%of oontxsct price with a(Minimam Fee of$50.00) <br /> 1'� AD �.oi2s$. �Lt�•3 <br /> (conuaotpricc) (m1�Umum SSo.oO) <br /> 2. BTATL SURC'I�AR,�F. <br /> ^' x,0005 $ <br /> (aontract price) <br /> �, POSTAGE&HANDLING(Only on Mail-In App�ications) $________ z,oa <br /> � 4, TdTAL PERMIT�'EE(Add Lrnes 1-3 Above) � �`��- Q.(� <br /> I ■ * CONTRACT PRIGE or JOB GOST means the actual or estimated dollar amount chargad �or tha <br /> i parmitted work including materials, aabor,profi�and other fixed costs. It is the amount to be charged <br /> I ta the customar for the work dono. If any material, equipment, ]nbor or installations are furnighed by <br /> '� the owner, tenant�r any other party, tha rcasonable mF►rket vnlue of such items must be added to tha <br /> � estimated cost. or eoz�tract price for permit feo purposas. In tlie event that tllere is a dis�ute on the <br /> ' amount of the job cost, the City may request the submission of a sig�ned wpy of the actuAl cani�act. <br /> The undersigned hereby �pp�ies to the City for issuazXce o�'a Mechanic�.l Perntit, agCees to do all <br /> wock in strict accordance with dza ordinances of the City and the regul�tions of the State of <br /> Minnesota, and certifies that al� statements made on this a�plication are complete, truo and <br /> correct. • <br /> Applicant's Si�maturo' Date: (f• �• ��� <br /> 3 <br />