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'Y����_ ' UI 1�7 <br /> Wo�� stove with flue <br /> ' � Woc�d cornbit�ation qr add-on <br /> �� Factory fireplace with f7ue <br /> �__ Fatcoty Fircplace {s) �___ Frecstanding � Masoruy <br /> WUai Sto�e (s) Franktin, other <br /> Branci Name Mode1 No. --.._._ ._ <br /> Mf�r's Miti., ('Ic;aranc:es, side ` rear , min. t7u� dia. � �� <br /> y�Nri�AT�S�N <br /> No. _ Kitchea t�xhaust ducted recir�ulating _ cfm <br /> No. .�_ Batti Lxhaust (must be ducted outside) cfiti <br /> No. ��� Chher F�ns: Locatians �� , cfm <br /> �� S'T(�}RAGE (MtJS1' BF APPROVf?D BY 1;IR� MARSHAI.) <br /> Installation Removal <br /> ___ Fuel �il:� _` gallons und�rground inside outsidc <br /> ..�� LP Gas: _ gallons <br /> _.__� Other __� Gas apening <br /> ,�- . �`• . <br /> �-',} ��'��-/7� ��:� �- y�/.�.�-.:l _ <br /> , . -.�� A" .'� <br /> ]. 1.25 7n of Can�rs�t Price* or ��Ln Fee �S3S.00) , , _� <br /> _ � " C��.� `- X .0125 $ _ ,��� . :�-,S <br /> (contraCt pricc)� <br /> 2. �tat� Surchargc� ** Add the State Building Code Division -� <br /> Surchargc to each pertnit. .��"�Z•Z_- _ x .0005 $ -� ='��-� <br /> ar $.50, whichever is greater {convaat pricc) <br /> 3. Po� aY��� !c� (Only mail-in apptications) $ <br /> 4. TOTAL YERMIT FE� (Add liries 1-3 above) $ r��f : � �' <br /> " CnNTR.4CT f�ftlC���r.fOB COS7'me�ns tha $ctu�il or s�timateti dollar umc�unt charged for the permictcd <br /> work ic�cluding muteriats, labor, pcofit, and othsr fixed cost.s. lt is thc amount to be ehar�ed to thc <br /> custamcr fur the wnrk�nc. If any mnterial, equipment, tatx,r, c►r installatic>n urn furnished by the owner, <br /> tenant or any other pntty che rr.�snnahle ►uarket v�lue of such items musc t�e acidee� to the esi�nated eost <br /> or coritr.�ct price for}xntylt 1'rc purpases. ln tha evertt thut there is n d�c�+utc on the amount of thC job cost, <br /> the City may requo6e the submission of a s9gned topy of the actusil coutract. <br /> '�'� 3he STATE SLItCF�ARGC is .(10�5 uf the contracc price under �1,OW,UW or 5.51) - whichrver is <br /> greatcr. Fnr v�uations ovrr .Sl,Op0,0()0 �all thc Depattmcnt of inspa;tional Services for tht price. <br /> The undersigned herchy applies tv thc Ciry for issuanCe of a Mechani�al Pennit� agrees ro ciu <br /> all work in strir.t accordance with the c�rdinant:es of the City anci the regulations of the Minnesota <br /> Statc Building Code, �uxi cettifies that all statements made on this application are romplete, truc <br /> and correct. <br /> , <br /> �_ <br /> _ � _, <br /> Applicant's Signatiue: �_ � -���._\ .. Dat�: ��� � 15- 3 <br /> _ �--------� _ <br /> Appmved BY: Datc: <br />