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.r-' � ' <br /> , , ' . . • . . - . <br /> . � .. � • � � .Wood stove with flue . . : . . <br /> � � �� �.Wood. combuaation or add-on ; , �� . . . . � <br /> � � � � '� gptctory fueptace with flue � " . ; :M�� <br /> . • . � � ��- Factory Fireplace (s} � , Freestandiug � . . ' . <br /> . .. .. ':��--��Wood SWve (s} � �rankli�, other <br /> 8rand Naxne Madel No. <br /> M�gr'� Min., Clcazaaces, side�� ���� rnin. �Iue dia. . <br /> Total <br /> ��_ .OL�I c�m <br /> �No. _� Kitchen Exhaust „� ducted ,� ����a���_— . <br /> �o, �� �a� �aust (must be ducted nuiside) � C� <br /> No. �,� Other Faas: Y.,ocatio�s �otal ` <br /> p�r� ST'O (MUST BB ,AFPRc�VED BY FII� MARSHAL) <br /> �ustallation ,� RGiuoval inside outside <br /> '�"+ F'uel oil: gallo�s � undexground � �� <br /> ����Lp Gas: ^� gallcns Gas opcnin$ <br /> � <br /> Other '+'� . <br /> �rn�,��►t� j,�+Ei {:LJ�.�F� ':35.00 <br /> _ - , �� <br /> 1,,. s 1.25% flf c•_nn act P�i�e'" or � x .4x25 $ ��, a5' <br /> � <br /> " (contract pzice} <br /> 2. <br /> �SEate Sure o. ** Add thB State J�u�din$ Gode Divisioa � �� <br /> . Surc�argc tv cach perm�t. �s�.� x .0�+�� <br /> . � {Contr�ct price} <br /> or $.50, whiahevex is $re�ter l��ations} $ i.SQ <br /> 3. , d and i (Only n;ail-in app ' $ �G.U <br /> �. TQTAL PBRMIT FEE {Add-lines 1-3 abave} . <br /> * CON'�'RACT P1tICE or J0�COST means the xctusl or estfmat�T°�s the smount tc be charged t�o th <br /> work Ir�ctuding materials, labor. profit. and o�e��d��or installatxon are ftunished bY the owner, <br /> custamer for the work doue. If auy a�a�erial� eq p <br /> tenaat or suy other garty the reasoaases. In shet eat that there is disput on the am;ount of the job costt <br /> or cantract pria fot permit fe.�pur'Pa af the actval contrac.t. <br /> the City ma�► recNest the sub�sission of a aig�r,t3 coPY <br /> Tha STATE SURCI�ARGE is .0005 of tha contract price under �1.000.004 or S.Sp - whichever is <br /> *'" ppp r,ait the Dtpartrnent of Ynspectional Services for the price. <br /> �rester. Fot valvscioas over 51,000� <br /> 'The undersigaed hereby applies to the City �or issuance of a Mechaui���tth�Minnesota <br /> • with the ordi.n�nces of tt�e City and she reg� . <br /> all wark�a stcxct aecordance hcation are complete, uue <br /> State Buildiag Code, and cerkifie's that all stausncuts �ade oa this app � <br /> . <br /> ....:.,�.corrc�t.-�-., . � •-- _ Date: � � � <br /> , . , ,_ ,.'^,�_�;«':a` . <br /> . Applicant'sSig��� <br /> .. . . .,,.�... M�S ,2, ow�s :Date: . , <br /> �� � APFroved By:�ti��- . _ � <br /> . �.� <br />