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07/19/2010 MON 8: 48 FAx 763 473 8565 Sabre Plumbing & Heating �003/003 <br /> 1't;RI��I I;�Ll G�1�C`C,7I ATICJN{S) : F <br /> �A�3��D�3I'I;-�002��'�'�"I'I' �`I'r1T�' ; <br /> -- — �. <br /> � Yes,this sectio�i applies <br /> The replacement of a$esidential fixturc or annliance that meets al!three of the foltowin�requirements: <br /> 1. poes not require modification to electrical or gas service. <br /> 2. l�as a total cost of$500.00 or{ess; ud'n 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 Permit $ 15.Op <br /> State Surchar�e $ 5� <br /> Mail-In Fee(IfApplicable) $ 2.00 <br /> Tota! Permit Fcc $ <br /> ��� � - �.. �. <br /> If above does not apply; follow guidelines below: <br /> 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fce of$50.00) <br /> i <br /> _ (�������.�� X.oizs s r���.�� <br /> (contract pricc) (minimum 550.00) <br /> 2. S7'ATE SURC1iAKGE **Add the State IIldg Code Div.Surcharge(Minimum Fcc of 55.00) <br /> _ Cp��. U%� X.000s $-- ���G Z� <br /> (convact pricc) (minimum S 5.00) <br /> 3. POS"TAGE&I-IANDLING(Only on Mail-Tn Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Abovc) $ �L�J � <br /> ■ * CONTRACT PKICC or JOB COST means the actual or estimated dollar amount charged for the <br /> pennitted work including materials, labor, pro6t,and other fixed costs. It is tl�e amount to be charged <br /> to the customer 1'or the work done. lf any material, equipment, labor or installatiot�s are funtislied by <br /> the owner, tenant or any other party, the reTsonable market value of such itcros ntust be added to the <br /> estimatcd cost or contract price for pennit fee purposes. In the event that there is � dispute on the <br /> amount of'the job cost, the City may rec�uest the submissioii of a signed copy of the aetual contraet. <br /> ■ **The STATF_SCJRCHARGE is.0005 times the Contraet Price or a minimum of$5.00. <br /> r �: ' s <br /> The undcrsi�ned hereby applies to the City for issuance of a Mechanical Per►nit, agrees to do all <br /> work in strict accordance witl� the ordiiiances of the City a�ld tlie regu[ations of the State of <br /> Minnesota, and certifies that all statements made on this application are complete, true and <br /> correct. <br /> -, <br /> � ` " � � i ;> <br /> Applicant's Si�nafure: �.-(�..� : Date; `(� <br /> �, , ;.�� - <br /> ��- .�' - 3 <br />