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, O1'/31/2014 FRZ 12: 54 FAX 763 473 8565 Sabre Plumbing & Heating �007/007 <br /> I <br /> _��_._—___ _ � �'����������������'` �_._._ � <br /> $� �4' ;� ���� �r� �l��J����' r��D���'�`�'��a��'��� ; 7 � <br /> � Yes,tliis sectiou applies <br /> '1'he replacement of a Residential fxture or ap,�liance that meets all three of the following requirements: <br /> 1_ Does not reqoire modification to eiectric,�cl or gas service. <br /> 2. Has a total cost of$500 00 or less;excludinr�the cost of the�xture or appliance:and <br /> 3. Is improved, installed or replaced by die homeowner or licensed contractor. <br /> Skip next section,if this applies; Cost of Pern�it $ I5.00 <br /> State Surc(�ar�e $.� 5.00 <br /> Mail-ln Fee(If Applicab(e) $ 2.00 <br /> Tofal Permit Fee $ <br /> ��.. � p <br /> ;��,��. <br /> If above does not apply; follow guidelines below: <br /> I. CON7'RACT PR10E *is 1.25%of contract price with a(Minin�uni ree of�50.00) <br /> _�1.���.0� x.oi2s� i3S�(�o _.__-- <br /> (controct pricc) (m in imu m 550.00) <br /> 2. STATE SURCHARGF� I O 41'!` DO 'I <br /> _ ���>j _.._x.0005 $______�_7�Z-..__�- <br /> (contiact price) <br /> 3. POSTAGE&HANDLING(Onfy on Mail-Tn Applications) $ �-99� <br /> 4. T01'AL PERMIT FEE(Add Lines I-3 Above) $ ���.Q� <br /> ■ * CONTRACT PRICB or ]OB COST means the actual or esticnated 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 vatue 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 t}ie <br /> amount of the job cost, the City may request the submission of a signed copy of tl�e ach�al contract. <br /> 1`he undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all <br /> work in stract accordance with die ord'u�ances of die City az�d the regulations of the State of <br /> Minnesota, and certifies d�at all statements made on this application are complete, true and <br /> conect. <br /> Applicant's Signature: c��l4d'Ib�,v�-- � �tFi�, �/(�� Date: �� J��- �.�J� <br /> II �i � V' 1 <br /> .� <br />