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1�1:f�1�:�94 r�q:42 THE ��I T1" rF nRC�h�lr 61�—�73—r'357 ��3 <br /> . <br /> � s ' ' <br /> � � ' � , <br /> WQOD �GURNINC E UT�MENT <br /> � Woad stove with flu� <br /> Wood combinativn or add-Un <br /> ....,�.� �actory fire�lace with flu� <br /> �� �actory rirepl�ce {s) � �'recstanding Maconry <br /> � �JVood Stove {s} Frankli��, oth�r <br /> Br��nd Nan�e Model Na. <br /> N[f.'gr's Min., Clearances, side __ _, r�;ar__R__T, �nin. #�tte dia. _ _ � <br /> Total <br /> VEN�' '�,c� TI N <br /> ly�, Kitchet� �xhat�ct cl»cted recirculating __ �fn,. <br /> �;c. �� �S�t� F,xha�st (Fnust be dticted o�tside) c:fm <br /> Nc. Oth.�r Fans: Locations cfm <br /> � Totai <br /> FL]�L STORA� (M'UST BE A.PPRQVEI} B'Y rIRE �ARSH,A.L) <br /> i�L�tallation Rei7�ova1 <br /> __� Fuel oit: gailo�i� unciergroi�nd inside out�;ide <br /> �__ �,P Gas: � gallons <br /> --- Olhcr ___ C�s c��ening <br /> PERIIZIT FEE C�4,X,,,C ATIQN <br /> �. 1.25% af �antract Price* or Minimum Fee {�35. Q) <br /> , <O DO. 6�_ x .O l 25 � ,3.5 6�_� <br /> (contract price) <br /> 2. 5tate Su�'ci�ar�e. ** Add the State Buildir�g Code Division <br /> Stt�charge to each perrnit. _ l DD4•oo x .00QS $ . S('� � <br /> (c�n.lract (�rice) <br /> or ��.50, whichevez is �reater <br /> 3. Pr�<�tage and Fiandiiz�� {Qnly r�iail-in appiications) $ �.SO � <br /> 4. Tt�TAI.� PER�IIT �'�� (Add lines 1-3 ahove) � 37• ��____ <br /> * Ci}'.v'TR�.CT PRICE or JOB C�ST rrie�ts the actnal or estimated doltar�-nt:uiit chxrgc� fUr ttle pern3ittzd <br /> wt�rk incluciing ma�crials, labor, prafit, and other fixed Costs. Ic i5 t�,e atllvt113t tD bc chargcd in the <br /> cust�rner far the work done. I€any m�teri�l, equipineat, labor,or instalSatioc�arc fur�ishzci by ihc ow,�or, <br /> tcr.;ant or dr,y other party d�e reasonabie market vatuc of suclr itetus iuu�t be added �c� thc estil��aced �vost <br /> or c,>ntract ptice for permit fee purposes. tn the event r�tat chere is a dispute c�n thc amouut uf tlte ji,b cost, <br /> the, ;ity rnay re�uest the submission of a sigued �u}�y i�f the actual contract, <br /> '�� The STAT� SURCHARGL• is .0005 of the con[racc prlce under $l,tX�O,OCKl or �,SO - whichover is <br /> �re:a�er. Fc�r vaiva[�ans over $1,000,000 c�ll the T�e�artmr.n� �f In�}�cz;tii�t�� Scrvius for ihe pricc. <br /> '1'�� unci��r�,igne�i hereby ap�lies W the City for issuance of a Mech�u�ical �er�mit, agre�s to do <br /> �,ll work ia strict accordat�ee wi�t [tYe ordinances bf the City and the regu�atic�i�.s af the Minnesuta <br /> State Buil�3ing Code, ��d eertifies that all statements mac�e on t2us ap�iication are c��il�pletc, t�ue <br /> and cone��c. <br /> Applicant'�,Si�nature: � I�ate: �D _ <br /> Approved�3y: _ Date: �-- <br />