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! � <br /> . <br /> �UQp BURNING ��Ut <br /> Wooci stove 'th flue <br /> _____. �ood c�mbina ion or add-ou <br /> ,_� Facrory �replac with tlue <br /> �! Faccoty Fircptac (s) �___ Freestanding Masonry <br /> Woocl Stove (s) Franktin, otizer <br /> Hranci Name Mode1 No. <br /> Mfgr's Miu., Clc•,xranc;�s, side _` , rear , min. flue dia. � <br /> Y.�e1vTi�r.�lT)UN <br /> No. Kitchea �:xhaust ducted recircutating cfm <br /> No. � Bath Lxhaust (must be ductcd outside) cfm <br /> No. Other F�ns: Locatians cfm <br /> �,J�,�'F�1�AGE (MUST BF APPROV�?D BY FIRE MARSf�AL) <br /> Installation Rem�vai <br /> Fuel Qil: gallons underground inside outside <br /> _,�� LP Gas: galluns <br /> ,—,-----_ Other _^...., _ Gas opening <br /> P�'r�T� �i�'r CAI�4ULA��.�N <br /> !. 1.25% of C�n{�afit Pricc* or �+jjti�mucn Fee (S3S.00) <br /> _ 7 f c5� " x .Ol ZS $ �f� .��S� <br /> (contraCt prica)� <br /> �. �tat,� Surc:ha�; *"' Acld the State Building Caie Divisian <br /> SurchNrgc to each permit. . x .0045 $ ��� <br /> or $.50, whichever is greater (concreac pria) <br /> 3. Po�� and Ha� li i (Qnly mail-in applications} $ __ ,�,54 <br /> 4: TOTAL �ERMIT kF.E (Add lines 1��3 above) $ <br /> " CONTRACT Pf11C�ar 1UB COS7'meana the aetu�il or eatimated dollar um�unt charged for thc percqieted <br /> wo�k including mattrials, labor, protit, and other fixed costs. it is thc asnouut lo be �h�r�ed to thc <br /> ctwt�mer Pur the work�xie. If any tnaterial,equipmeat, labor,or installation nrc furnished by ttu owner, <br /> tenant or any ether putty the reasnnable market value of such items must t�e added to the estunated Cost <br /> or caacract�rlce for pen»tt fCc purpaaes. ln tha event that there is a disputc on thc amount of thc job cost, <br /> 1hc City may request the submiaaion of a �9gned copy of she actaal coutract. <br /> "* ?he STA7E SURCHARGC is .QIXlS uf the contract prict under 51,000,000 or S.SO . whichever is <br /> greator. Fnr v�uations aver S l,OQO,flQO call the D�part►nent of Inepection�t Services for tbe pricz. <br /> The uncicrsigned hereby applies tc� the City for issuance of a Mechanicat Pecmit, agrces to do <br /> ali work in strict accurdaru;e with thc vrdinanc:es of the City anci the regvlacions of the Minnesota <br /> Statc Buiidit�g Code. �i c�rtifies that all st$tements made on this application are romplctc, true <br /> and corrrcc. <br /> Applicant's Signatiu�e: - - - y��� Date: _�r�_—3 <br /> �—. ._. <br /> Approved By: Date: <br />