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� - <br /> woc�� �unn�..Y� ���� <br /> Wooci stove with flue <br /> ~ � Wood combivation or add-on <br /> ,_� Factory fireplacc with flue <br /> Factoty �ircplace {s) �� Frcestanding Masonry <br /> Wooci SMve (s) Franklin, other <br /> Brancf Name Model No. <br /> Mfgr's Misi., Clc�xrdnc;es, side .r , rear � min, flu�dia. <br /> YEN7'1I,ATlUN <br /> No. Kitchen Exhaust ducted recirculating efm <br /> No. �_ Bath I:xhaust (must bc ductcd outside) cfrn <br /> No. _. __ Other F�ns: Locations cfm <br /> �EI. S,�}�AGE (MU ' BF APPROVED BY fiIRE MARS��AI.) <br /> Installatiun Removal <br /> Fuel Qii: _ allons undcrground inside outside <br /> _�.,.�. LP Ggs: g ns <br /> �__ Other �� _.__..._ _____... Gas openirg <br /> 1'��� ' '�'rS�B1 ��A�'1Oty <br /> 1. 1.25% of '�.ct�tra�t Pricc* or �� ee (��.Q,Q �-- <br /> ')/ O o x A1ZS $ _�`�� <br /> (contract pric�}� <br /> 2. �tate Surc;ha� ** AcW the State Building Ca1e Division <br /> Surch�rRc to each pertnit, x .0045 $ .5 S <br /> ar $.50, whichever is greater (concreac price� <br /> 3. �o,��� and �iancilins� (nnly maii-in applications) $ __ 1.50 <br /> 4: TOTAL PERMIT F�.E (Add lines 1-3 above) $ <br /> * CONTRACT PFt1C�or�(�B COST meane tha actwsl vr aatimate�i dollar umouat charget! for the peraqitted <br /> work including ma�eri�ls, labor, prufic, and other fixed costs. ]t is thc amouut to be char�ed to thc , <br /> cu,itomcr fur ths work ei�ne. If any materiaJ,equipmeat, labor, or installation src furnishsd by the owner, <br /> tenarst or any ether party t6c rea+onat�le ivarket v�lue of s�uch itcros must t�e added to the escunated Cost <br /> or ccn�uact prSce foc penntt icc purpases. In tha event rhut there is a dis�+utc on tt� amount of thc job cost, <br /> �hc Cicy may requese tbe submiaaion of a�igaed tQpy af she acroal cot�tract. <br /> w* 'fhe STATE SURCtiARGC is .U0�5 uf the contrna price unde� S1,OW,OQO or 5.5�) . whichcver is <br /> greator. For valuations ovcr 51,000,000�all the Dcpartment of Inepectional Scrvi�Cs fur the price. <br /> The undersigned hercby applies tc� the City for issuanee of a MechanicaI Permit, agrces to do <br /> all w�rk in strict accordan�;e with the vrdinanc:es of the City anci the regulations of the Minnesota <br /> St$tc Bultding Code. suxi certifies that aU statements made on this application are complctc, tnie <br /> and cocr�ct. <br /> Applieant's Signature: Date: _��� <br /> Approved BY: Date: <br />