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02/28/2013 THU 13: aa FAX 763 473 6565 Sabre Plumbing & Heating �007/015
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<br /> ❑ Yes,tl�is section appties
<br /> Tlie replacement o£a T2e�sidantial fixturo or enuliance that meets at!three o£die folEowin�'requirements:
<br /> 1. Does not.require modification to clectrical or gas service.
<br /> 2. I�as a total cost of$500.00 or less;excl in the cost of the fixture or appliance:and
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<br /> 3. Is improved,installed or replaced by the homec»mer or licensed contractor.
<br /> Skip next se�tion, if this a�plies; Cost of Permit � �� $ 15.00
<br /> State Sarcharge � 5.00
<br /> Mai(-Tn Fee(If Applicab(e) $ 2.00
<br /> TotAI Perniit�'ee S
<br /> C'"'i"". !�0_3 THU l't� �: . '?T1k 76?• 473 tl!-,'�q. �ta.b-e P1,trn2 i.na & ;=-�+-inq f�.q077('1�
<br /> If above does not apply;follow guidelines betow:
<br /> 1. CON'�'RACT PRiCE * is 1.25%of contract price v,rith a(Minimutn Fee ot'$50.00)
<br /> �';`' ,`� C��.' x.01.25 � � ��,. �? :,� 1
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<br /> (con[ract price) (mintmum 550.110)
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<br /> 2. �'A'►'.�,i��CHARGI� t
<br /> ,1 � `,���'�,� �.0005 $ +' i#� :
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<br /> _ ._ _ : �Con�rnot'price) .,.. __. _.. .: ..__,.. .... •
<br /> `-- 3'`1�0��'1'�''�'�i �" '.t�1L1NG(Only ai Mail-In Applications) $ 2,00
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<br /> 4. TOTAL PERMTT FEE(Add I:.ines 1-3 AUove) S i ,,'..:`�j ' ') :�'....
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<br /> • � CONTR�R����R��oir J013'CO�T�tiry�x.tiis`�k��'a�btt�a'1'or esti�Tiated'dollar'ac'tldill4f'�ha'r�d for the
<br /> permitted`�v�i�'�it�cludir�g`mater'ials;'!�aF3at, p�o�i'�'a"n'ff'bt}�er fixe�d rosts. Yf 5s`tlie�t�hount to be cl�arged
<br /> to the customer for tl�e work done. If any material, equipment, labor or installatioi�s aze furnished by
<br /> Che owner;j`tf��'h��"o'r`�t4�''other. pat�y�"[h�r�sonA�il'e'h�titbt'value of s��ch itetns must Ug-ac#d�i1=''to the
<br /> estimated cost. or contx•A.et price fc�r perznit fee p�Ijiose$': In the evcint tliat there is''a-dispiit���on thc
<br /> amount of the job cost, Ylie Cit.y mfly request the'"�siidi�iss�on of a'signed'aopy of the ac�ual ebiitract.
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<br /> Tho undorsigited hereby appIies to the City far iSsuance of a Mechanical Permit, agrees to do al]
<br /> �+ork ira sU'ict accordance wiYh the ordinances of.F.hi� Cify an.ci the regiataiions.of_tl�e.Strite of
<br /> Minnesota, and certifies that all statements ma�ie bh`this application are �H4y`l�1�4e,'�i'ue and
<br /> coi�rect.
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<br /> Applicuit's Signature. �tf,1 l.{�,�.-.���j, a,�.�t�cf.L:U''�.: Date � `� �!C /��
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