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<br /> i('{+ �y. �y- ��th `�$ $ � .,y 1h� . �i_� 1 .
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<br /> � _������ � �g � .,� `t-$ a.. ,p�'£�;
<br /> � 3* a �F�.��k $ ',� �, a :' � . .,i v+��, �
<br /> ��c�[�' '' *,'�s� � s.��� t' '��h � { r` v � $��
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<br /> F *WOOD BIIRNING EQIIIPMENT $15.00 each unit �` ��"`��
<br /> � °�
<br />��� Wood stove with flue ' �.
<br /> ' Wood combination or add-on unit � � ��
<br />�
<br /> � Factory fireplace with flue ��"�,
<br />� Factor Fireplace (s) freestanding built-in "�' +
<br /> ,
<br /> s�t Wood Stove (s ) franklin, other � °
<br /> ,�;, BrandName Model No. �'' '
<br />�„
<br />�:� Mfgr' s Min. , Clearances, side , rear , min. flue dia.
<br /> �;
<br /> m Total
<br />�.� ********************************************************************************
<br />� VENTILATION $15.00 each project t
<br /> ,�;; � : z �t�
<br /> � No. Kitchen Exhaust ducted recirculating cfm �� �
<br /> � No. Bath Exhaust (must be ducted outside) cfm �
<br /> , �:.
<br /> ' No, C1th�r Fans: Loc�tioz�s cfm
<br />�� Total
<br />��; �;
<br /> ********************************************************************************
<br />��>,: �
<br /> '' FUEL STORAGE (must be approved by fire marshal) -
<br /> ��
<br /> " $30. 00 Permanent/Temporary
<br /> " Fuel oil, gallons underground inside outside .
<br />�� LP Gas, gallons
<br />�_
<br /> Other Gas opening
<br />=:;
<br /> ********************************************************************************
<br />;:><'�' GAS LINE INSPECTION
<br /> High/Low Pressure $15.00
<br /> - ********************************************************** * ****************** "�
<br /> P$RMIT FEE CALCOLATION �
<br /> � � .
<br /> �`' 1. Total of above Installations or Minimum Fee ($30.00) $��• G`-' �
<br />��;: 2 . State Surcharge. Add the State Building Code Division °��•` �:����
<br />°P Surcharge to each permit $ . 50 � �; � '
<br />` �' 3. Postage and Handling on all mailed-in applications, $ 1.5D ,-
<br />� 4 . TOTAL PERMIT FEE add lines 1-3 above �' $ ��,C�C- � _
<br />, The undersigned hereby applies to the City of issuance o c �anical Permit,
<br />�;j agrees to do all work in strict accordance with the ordinances of the City and
<br /> r;�' the regulations of the Minnesota State Building Code, and certifies that all �
<br />�F=`'' statements made on this app lication are complete, true and correct. �
<br />� . ��� '���
<br /> ,` A licant' s Si nature: ` �� Date: ( � -�-� -�� ° ?�,,�
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