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06/30/201a MpN 12: 5� FAx 555 5555 Sabre Heating & air Cond �007/007 <br /> -` ./�- - � <br /> o� ��� ' ; � <br /> � YBS,th;s sectio❑applies <br /> Tlto replacoment of a Residontial Fixture or a�,pfiance that msets a11 three of tha�olfowing reyuiramerzts: <br /> l, �oes not require modification to elechical or gas sarvice, <br /> 2, Hxs a total cost of$500.00 or less;axcludin�tha cost of tha fixture or�pgliance:and <br /> 3, Is improved,inst2�lled or replaced by dte hpmeowner or licensad contractar. <br /> Skip naxt section,if this�pplies; Cost of Pemtit � 15,00 <br /> State Surcl�arge $ 5.00 <br /> Mai]-Yn T�ee(If Applicable) x 2.00 <br /> Totnl Porinit Fee S <br /> If above does not apply; follpw guidelines below� <br /> 1, * is 1.25%�f contract prico with a(Minimum k'ee of$5�.04) <br /> � n x.0125 $,�.,�O'�� <br /> (con actpnce) (mtnlmumSS0.00) <br /> 2. STATE SURCHARGE <br /> �'��.u� x.0005 $ <br /> (coetrnot prica) <br /> 3, PUSTAGE&HAIVDLING(Only on Mail-in Applicntions) � 2.00 . <br /> 4, TOTAL PERMIT FEE(Add Lines 1�3 Above) S <br /> • � CON'�RA.C'� PRTCE or JOA COST masns d�e actual or ostimated dollflr amount charged far the <br /> parmittad work i��cluding matorials,labor,profit,and other�ixed costs. It is the amvunt to be ehargecl <br /> to the customer for the work done. If r�ny material,equi�ment, labor ar installations are furnished by <br /> 1;he awner, ten�nt or sny other pari.y, the reasanable market ve,lue of such items tttust bo edded to the <br /> estimated cosi or caitract price for permit fea purposes. ]n t.he event that thare is a dispute on the <br /> �mount of the jab eost, the City mAy requea[the submissiota of a signed cvpy of the actual cantraet. <br /> i <br /> 'I1�a u�.derszgn�ad k�ereby applias to tk�o Ciiy for issuance of a MechanicAl permit, �grees to do all <br /> work in striet aeeordance with the ordinences of the City az�d the regulations of the State of <br /> Minnesota, and certifies t��at a�l statemants mad� on this application a�-e complete, true and <br /> co�roct. <br /> Applicant's Signaturo: � D�te: • � � <br /> , �, . <br /> 3 <br />