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08�2�/20i2 TUS 11: 20 FAX 763 673 8565 Sabre Plumbing 6 Heatinq �J007/007 <br /> w . r <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appiiance U�at meets ail three of the following roquiraments: <br /> l. oes not require modi�cation to electrical or gas service. <br /> 2. Has a to J of$500.00 or less; u i the cost of fhe fixtu�e or appliance: and <br /> 3. Is improved, instaUed or replaced by the homaownar or licensed contxactor. <br /> Skip next section,if this applies; Cost of Pertnit $ ]5.00 <br /> State Surcharge $ 5.00 <br /> Ma.il-In Fee(I£Applicable) $ 2.00 <br /> Total Permit 1�� $ <br /> �" ^� ''^� '" If above does not apply;follow gvidolines balow: <br /> -._ . _ . <br /> 1. CON'���,�'I'RICE * is 1.25%af contract prico with a(Minimum Fee oC 550.00) <br /> �S�� .Q� X.o�as$- _ q'1-q� <br /> (conUaot pricc) (miuimuro$50.00) <br /> 2. S'l'ATE S�fRCHARGE <br /> � ���� CJO x.000s $ 3�Z. <br /> (conUao�prioo) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applicaiions) $ 2.Q0 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) S__ �Q{.vi(� <br /> • � CONTRACT PRICE or JOB COST means the actual or estimated dollac annount charged fa� the <br /> permitted work including materials. [abor, pro�it,and other fixed costs. It is the amount ta be charged <br /> to the customer for the work done. If a�iy material, equipmant, labor or installations are furnished by <br /> U�e owner, tenant or any odier pariy, the reasonable market value of such items must.be added to flie <br /> estimated cost or contract price for permit fee purposes. In the event that there is a dispure on tlie <br /> amount of the job cost, the Gity ma.y request tfie submission oP a signed copy of the actual contract <br /> The undersigned hereby applies to the Ciiy for issuance of a Mechanical Permit, agrees to do a11 <br /> work in strict accocdance wilh the ordinances of the City a�id the reguIations of the SCate of <br /> Minnesota, and certif"ies that all statoments made on this application are complete, tnae and <br /> corrc�i. <br /> Applicant's Signature: ���� I ^ Datc: ' Z K• �Q(Z <br /> `�-� <br /> � 1 1 <br /> 3 <br />