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r�r_-� �,i`=i T�H�� 1 -�_ F'1�i I���."E�` _ .�,F'F'I,I: ���I�'_�� �.... . _, :�1 .. _ ! �_E_�i=i�� P, 4
<br /> . LLlY-�r uKu��y � ��' 612�49461b 04I22/�9 13:48 � :03/05 N4:8��
<br /> w(��,BURx�rr(;�F.n1FT���
<br /> ,�.�, WoOd �tove w ith fluc
<br /> � Wood cornbination or add-an
<br /> �, Pactory fir�p1ace with t�ue
<br /> ,�� k'actary Fireplacz (s) �..� Freestanding Maso�try
<br /> Wood SWve (s) Franklin, oth�r
<br /> Hrand NRme --- -.��... MadG1 No. J
<br /> Mfg�''s Mit�,. Gie&rAm;es. sJrl� .�, re�rf,�� nlin. ftue c3ia� . ,�T
<br /> ���
<br /> �I+a. � Kitchen Exhauat _ duct�d recxrculatir� �_____ c�m
<br /> I�o. � Bath Hx.haust (must be ductEri autSiQC) Cf'[r1
<br /> 1*to. _-..` �th�r F�ns: �.,c�atiuns __� �^� � Cfm
<br /> �'L�?,.,,c.,�'��� (a►QUST �3; AP�'ROVEI] BY FIR� ;MAR,SNAL)
<br /> __� Inst�ltation �, Rernoval
<br /> _,,, Puel 09l:� gellons undergro�lncl _ insid� ourside
<br /> �_ _ ,_ �P f�as: ---�_ _ Sallons �--- _-:_.�
<br /> Qthcr C�s o�ni�]g
<br /> �e�i`����,.�I�4'�'iC7K
<br /> 1_ 1.2.5°�, of�X i e* c3r QQ�
<br /> x-
<br /> - ��?�€;.u � x .Oy 2g $ __�,���%���- �'`�
<br /> {Garur�t.ps�ccj
<br /> 2. ,�I�.t�L��y *'" Add thC ,5tate Br��ldl'ng Cix]e T]it-isinn
<br /> Surcher�� ta eaci� permit. �1�'_�:�,.(� x .ppp� � , ���`, <�„�
<br /> t�r �,�0, WhiCh�vCr is greSteC (contrect pt�c�}
<br /> �� ' „� (dnly rr�ail-in appliratfons) � _ ��d
<br /> �l, 'I'�I'AL �'�R.�vI1T FF'.�, (Ad� lines 1-3 ahave) $ .- ---_-�,,� ; �
<br /> �` CON�A�T PRlC�.o�r JL1B C4S�'tntAt�.v thd e�tual �estimated d«llax' amqunt chdt�ed for the permittecl
<br /> wo�k inriuc�ing ros�erla�s, tabor, profi�, �nd nthar fixed fi4stS. It is thC nmount �v be ChAi'gA� to the
<br /> �u9tOtntr far t,�tC work dot�. 1f any rna�u�ial,equigtncnt, ta�r, vr�ns�a]tarion are futri�shed by ihc awnrr.
<br /> tcnant pe any othcr paKy ►hc reasanablc rnarket valuc of auoh itet��s m❑vt }>e sdd�d to the csllm�ted cnst
<br /> �r c�ntract price fas permit Fee pury�c+ses. In �rc cvcnl �ac ��ere is a dlsputc on thc amount nf t}�G job�ost,
<br /> cttie city muy raqvest tho auhmission of a sigttcd c�py aC�c actusl con�racc.
<br /> '"'" TIYe STAT�; 5URCHARO� is .p045 of the contracr prfce under 51,000.0(►0 c.r S,S() .. whichav�r is
<br /> grcarer. �or valuaiions over 31,UOO,Opp c�l! th� 17eparttntnt of Invpec.�lon�l Serv�Ccs for th� prirc.
<br /> '�'1�c undersi�ned r►er�by applies ccs �t�c Gity for issuancc of a Mechanical Permit, agr�es to iic�
<br /> AI1 WOi'EC in strict �r�orciance wich �e orditiaraces uf t1;e �i[y atK4 the regulations of the Minne��ta
<br /> SCaiG �3uildir�g Cpde, �nd certifies that atl statetnents snadc an this appli�atian are Gc�mpleCe, trtae
<br /> snd cc►rrect.
<br /> A�iplit�tit'� �iqt�ture: ------ l�atc: - ��?
<br /> Ap�inved i3y: .,.........._... ' _ .�.�._.v.--------..�..;._._..,�. -��., ��ke: � � �-1
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