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10/16/2015 FRI 10: �6 FAx 763 a73 8565 Sabre Heating b Air Cond f�00a/OOa <br /> r. <br /> r� <br /> �i <br /> 0 Yas,this section applies <br /> The replac�ment o�a 13gs►denta�)�xture or an�liance tbat meeta a!1 three of the following reyuiraments: <br /> 1. I?aas not require modi�c�tion to electricxl or gas sarvica, <br /> 2. Has a total,cost of$500.00 or less; x 1 in the cost of the fixtura or appliaince; and <br /> 3. xs imp►�oved,i��atalled or replaced by tl�e hotr�eowner or licens�d contractor. <br /> � 5kip noxt section,if this applies; Cost of Permit � 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applica,ble) $ 2.00 <br /> Totnl Permlt'i�ee S <br /> If above doeg not apply;foliow guidelines below: <br /> i <br /> 1, CONTRACI'PRTCE � ta 1,25°/a of contraot priQo with a(Minimum Fee of 550.00) <br /> �J��1a�0.l7� x.0125$ "l�`�J,� <br /> I (coritract prica) (rnlnlmum S�U.00) <br /> 2. - - - �----. ...... ._ ---. . ... . <br /> li �7 x,0005 $ ���(�, <br /> (can ect p ce) <br /> 3. E'QSTAGE&HAI�?DLING(4nly on MBiI-In Applications) $�0��.__ <br /> � 4, TO'CAL PERMIT FEE(Add Lines 1-3 Abovo) $ ����7J�. <br /> �. _..._ <br /> � • '" CONTRACT PRICE or JpB COST mas�ls the actual pr estimated dollar amount ch�rged for the <br /> , pe��mitted work including materials, labor, pro�it,and other fixad costs. It is the amount to be chhZrrged <br /> to the customet for th�work done. If any matsrial,equipmant, labor or installations are furnishecl by <br /> the owner, �enent or any other patty, the re�sonablo marlcet value of such items muat bo added to tha <br /> e.�timQtied cpst or cantr&ct price for permit fee purposes. Tn the event Lhat there is a disputs on Yhe <br /> amount of the�ob coat, th8 Cify fp�y reQUeSt fhC 9U�miSSiOn pf�slgned copy Of t}1A dCtuBl COnh'B,Ct. <br /> The tuidersigned hereby applies to the City for issuance of a Meohanical P�rmit, agre�s ko do all <br /> wor� ir� strxct accordance wi�lx tl�o ardinances of the City and the regulRtions of the State of <br /> Mirulesota, a�id certifiea that all statementa made on this applicgtion are complete, irue and <br /> correct. <br /> Applicant's Signat�u•e: �(,11I�1� �d�A�L+W`+�w Dato: ��-((p•�p IS <br /> 3 <br />