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01/15/2013 TUE 11: 08 FAX '163 473 8565 Sabre Plumbing & Heating 2004/007
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<br /> 0 Yes,this section applies
<br /> The replacement of a Residential fixture or a vliance that meets all three of the following requirements:
<br /> 1, Does not require modification electrical or gas service.
<br /> 2. Has a total cost of$500.00 or I ss;excluding the cost of the fixture or appliance:and
<br /> 3. Is Unproved,installed or repla 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) 5 2.00
<br /> Total Permit Fee $
<br /> 01 i. /'7(1 _ — If abov-edges `i aWy;�follbw guidelinei below:' 1-'9- & `' tj,o ;c a'
<br /> I. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00)
<br /> (.R`.I -2-(_.) 0(. x.0125$ `iS'-\.(";t
<br /> (contract price) (minimum$50.00)
<br /> 2. ,STATE SURCHARGE
<br /> _ k.P.. 1 L.0 LIU x.0005 $ .- ,.,
<br /> _„_ _.. .. . . (contract pace)
<br /> 3.} POgtA '&HANDLING(Only on Mail-In Applications) $ .2'l�0
<br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ Pit p
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<br /> • * CO1 TI ker PRICE or JOB COST'means'the'hctual or esti4nated dollar atbodnt"ehargbd for the
<br /> permitted vSok including materials,'•labor,profit,and other fixed costs. Itis the'aniount to be charged
<br /> to the customer for the work done. If any material, equipment, labor or installations are furnished by
<br /> the owner;iehdiiit'Ar i0'other party) the reasonable'n>al-ket value of such items must be adde to the
<br /> estimated cost or contract price for permit fee purposes. In the event that there is'a dispute''on the
<br /> amount of the job cost, the City may request the'subhnission of a signed copy of the actual'-contract.
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<br /> 1 ''O.' __.t 1
<br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all
<br /> work in strictaccordance with the orditxances of.the City and the iegul.ations of.the State.of
<br /> Minnesota, and certifies that all statements made Oh this application are cblittil'b'te 'true and
<br /> correct.
<br /> Applicant's Signature ,y)al L-ek-t, E' .. t.:Gt Li'-,(,, ,IA-- Date: 1 ! G! >
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