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J • <br /> WOOD BURNING EQ�MENT <br /> Wood stove with flue <br /> VJood combination or add-on <br /> Factory fireplace with flue Masonry <br /> Fire lace (s) Freestanding _-- <br /> Factory P — Fratilclin, other <br /> � Wood Stove (s) — ModelNo. <br /> Brand Name , 1e�. _, nun• flue dia. <br /> Mfgr's Min•, Clearances, sid�, — Total <br /> �N'TILATION ducted recirculating _ �� <br /> No. _ Kitchen Exhaust _ — <br /> c <br /> Bath Exhaust (must be ducted outside) _— cfm <br /> N�• — Locations — <br /> No. Other Fans: Total <br /> L STORAGE (MUST BE APpROVED BY FIR� M�SHAL) <br /> � Removal inside _ outside <br /> Installation — allons underground _ <br /> — Fuel oil: — gallons <br /> — I,p Gas: _ g _ Gas opening <br /> — <br /> Other <br /> PE�TT �E CAI,CULATION 35.00 <br /> 1. 1.25% of Contract Price* or Minimum Fee�--� 1.25 $ � � �'C1�-�— <br /> (contract price) <br /> Code Division � C�� <br /> State Surchar�e. ** Add the State Building X .pp05 � <br /> 2. ermit. <br /> Surcharge to each p ��ntract price) 1.50 <br /> lications) � <br /> Posta e and Handlin� (��Y mail-in apP $ ' <br /> 3' T FEE (Add lines 1-3 above) <br /> 4. TOTAL PERMI ed for the permitted <br /> ed to the <br /> * CONTRACT PRICE or JOB COST ofi��d o�`��ed�ssd Itliaz�e �ountrto be charg�e o�er, <br /> work including materials, labor, p ' ui ment, labor,or installation aze furnished by <br /> customer for the work done. If any material, eQ P <br /> tenant or any o�er party <br /> the reasonable mazket value of t�e eti�a dmpute on the�uno�t ofith�e jo�t� <br /> or conuact price for permit fee p�Poses. In the event tha <br /> the City may request the submission of a signed coPY °f�e �ru� COntract. <br /> ** The STATE SURCHAKGE is .0005 of the contract p <br /> rice under $1,00�,� �r $•50 ' �'�chever is <br /> ater. For valuations over $1,00�>� c�l �e Department of Inspectional Services for the pnce• <br /> gre rees to do <br /> ersi ned hereby applies to the City for issuance of a Mechanical Permit, ag <br /> The und g lete, tnie <br /> ' accordance with the ordinances of the City and th aregu a�on�ef omp�eso <br /> ail work m stnct <br /> State Building Code, and certifies that all statements made on PP <br /> and correct. � „ _a_ <br /> � , ✓ �' � � Date: <br /> i <br /> Applicant's Signature: la_ �'� <br /> Date: <br /> ppproved By: ` <br />