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04/15/2014 TUE 12: 23 FAX 763 473 8565 Sabre Plumbing & eating �007/007 <br /> � x�� �,���'.�Y�.��`.�i.�'��J��.�U,�:�����''���� ___ _ _..___ '�:� <br /> ` �:31���'�(��`I' �00�`a'��'��51 A'�[�3 ,, <br /> [� Yes,this st�tion applies <br /> 77�e replacement of a]2esidential fixturc or appliance that me ali three of the following requirements: <br /> 1. Does not require�tiodification to electrical or g service. <br /> 2. Has a total cost of$500.00 or tess;excludin�the cost of the fixture or appliance:and <br /> 3. Is improved,insYalled or replaced b}�the homeo er or licensed contractor. <br /> Skip next section,if this applies; Cost of em�it $_ 15.00 <br /> State Su charge �_ 5.00 <br /> Mail-Iz� ee(If Applicable) $ 2.0a <br /> 7'otal I' rmit I'ee $ <br /> ;. _��V;�)V � r��� c <br /> 4`� .#!<; �;( <br /> If above does not apply;follow guidelines be(ow: <br /> 1. CONTRACT PRICE * is 1.25%of wntract pr ce with a(Minimum Tee of$Sf1.00) <br /> � �� x.0125$.�_����-�_�_—..�. <br /> (controct pri (minimum 550.(10) <br /> 2. STATESURCHARGE � r <br /> x.0005 $ lp=�� <br /> — -- ___------ --- ---- <br /> (conttact pci ) <br /> 3. POSTAGE&HAI�IDLING(Only on Mai!-In Ap Iications) $ .-�96""� <br /> 4. TOTAL AERMI'T FEF(Add T.,ines 1-3 Above) $ 1��.�� __ <br /> • * CONTRACT PRTCE or JOB COST means the actua or estimated dollar amount char�ed for the <br /> permitted work including materials,labor,profit,and oth r fixed costs. It is the amount to be charged <br /> to the cusComer for the work done. If any�7iaterial, equi ment, iabor or installations are furnished by <br /> the owner, tenant or any other party, the reasonable mar et value of such items must be added to tl�e <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 tl�e submi sion of a signed copy of the actuat contract, <br /> �w� , � <br /> ��.t> .-`�� <br /> The undersigned hereby applies to the City for issuanc of a Mechanical Permit, agrees to do all <br /> work in strict accordance with the ordinances of the ity a�id the regulations of d�e Siate of <br /> Minnesota, and certifies that all stalements made on this applicatron are complete, true a��d <br /> correct. <br /> Applicant's Signature: � Date: �{ I��7_�J <br /> `�-�--- <br /> ,,, , , , .,,,., <br /> ,,, <br /> 3 <br />