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04/07/2014 MON 15: 35 FAX 763 473 8565 Sabre Plumbing & Heating �J004/008 <br /> ❑ Yes,this section applies <br /> 'The replacement of a R�idential�xture or applian�e that meets all three of dte foltowing requirements: <br /> 1. D es not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or tess;excludin the cosl 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 $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.0p <br /> Total Permit�ee $ <br /> If above dces not apply;follow guidetines below: <br /> 1. CONTRAC'I'PRICE * is 1.25%of contract price with a(Minimum Fee of$50,00) <br /> ��..���d•�(� x.0125$ �-'1`'j <br /> (contract price) (minimum 550.00) <br /> 2. �TATE SURCHARGE '` �� <br /> �[�-�JI SL'�� �x.0005 $ �-�-��— <br /> (conVact pricc) <br /> 3. POSTAGE&HANALING(Only on Mail-In Applications) $ 2.00 <br /> •- .— � <br /> 4. TOTAL PERIVIIT FEE(Add Lines 1-3 Above) $ .���'� <br /> • "` CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the <br /> permitted work inctuding materials,labor,profit,and other fixed costs. It is the amount to be charged <br /> to the customer for d3e work done. If any material,equipment,labor or insiallations are fumished by <br /> the owner, tenant or any other party, the reasonable market value of such items must be added to the <br /> estimated cost or contract pnce for pecmit fee purposes. In the event that there is a dispute on the <br /> amount of the job cost, the City may request the submission of a signed copy of the actual contract. <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all <br /> work in strict accordance with the ordinances of the City and the regulations of the State of <br /> Minnesota, and certifies that all statements made on this application are cocnplete, true and <br /> oorrect. <br /> Applicant's Signature: C� ��d��(�� Date: �`I-7 �LDl� <br /> I ; <br /> 3 <br />