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01/19/2016 TUE 9: 26 FAX 763 473 8565 Sabre Heating & Air Cond 0004/004 ❑ Yes,this section applies The replacement of a RC;jdV1tialW&&rg gr anolianCe that meets all three of the following requirements: 1. Dpesno require modification to electrical or gas service. 2. Pias a total cost of$500.00 or less;excluding the cost of the fixture or appliance:and 3. Is improved,installed or replaced by the homeowner or licensed contractor. Slnp noxi section,if this applies; Cost afPeimit $�� T5.0 State Surcharge $ 5.00 Mail-In Pee(If Applicable) $, ,_ ,2.00 ToW Permit Fee S Millis If above does not apply;follow guidelines below, 1. CO�$i a k= "is 1.25%of contract price with a(]Minimum Fee of$50.00) -1(conlmetpncxi) (minimum SSO.00) 2. STA1;R% C ARA C. (conaact pri-) 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ -2,40 4. TOTAL P1 T PEE(Add bines 1-3 Above) I " CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted work including mewials,labor,profit,and other fixed costs. It is the amount to be charged to the customer for the work done. IF any material,equipment, labor or installations are furnished by the owner,tenant or any other party,the reasonable market value of such items must be added to the estimated cost or contract price for permit fee purposes. In the event that there is a dispute on the amount of the job cost, the City may request the submission of a signed copy of the actual crnrtract. I The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all work in strict accordance with the ordinances of the City and the regulations of the State of Minnesota, and comities that all statements made on this application are complete, true and COMMA. Applicant's Signature: Date: - )�t�l-Ullo 1 I