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� <br /> � <br /> FIREPLACES - <br /> / Gas factory fireplace <br /> � Wood burning factory fireplace with flue ���,�=r�i c��/�—���- `� ��-`-r <br /> Wood Stove <br /> Wood stove with flue <br /> (� ✓f-5 Brand Name�/�'`��I�S 5��h i Model No. :3�v J V�+--{�J�-I Z <br /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath E�aust (must be ducted outside) cfrn <br /> No. Other Fans: Locations �� <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) <br /> Installation • Removal <br /> Fuel oil: . gallons underground inside outside <br /> LP Gas: T gallons - <br /> Other � Gas opening <br /> PERMIT FEE CALCULATION � <br /> 1. 1.25% of Contract Price* or Mi ' um Fee 35.00 � <br /> , �'� j x .0125 $ . <br /> - (contract price) <br /> 2. State Surchar�e. ** Add the State Building Code Division <br /> Surcharge to each pernut. x .0005 $ <br /> or $.50, whichever is greater � (contract price) <br /> 3. Postage and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ __ <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted <br /> work including materials, labor,profit,and other fixed costs. It is the amount to be charged to the customer <br /> for the work done. If any material, equipment, labor, or installation are furnished by the owner, tenant or <br /> any other party the reasonable market value of such items must be added to the estimated cost or contract <br /> price for permit fee purposes. In the event that there is a dispute on the amount of the job cost,the City may <br /> request the submission of a signed copy of the actual contract. <br /> ** The STATE SURCHARGE is .0005 of the contract price under$1,000,000 or $.50 -whichever is greater. <br /> For valuations over$1,000,000 call the Department of Inspectional Services for the price. <br /> The undersigned hereby applies to the Ciry for issuance of a Mechanical Pernut, agrees to do all <br /> work in strict accordance with the ordinances of the City and the regulations of the Mirinesota <br /> State Building Code, and certifies that all statements made on this application are complete, true <br /> and correct. � <br /> i j <br /> Applicant's Signature: �_ - ' ��� �1��� Date: ' �� 'o z <br /> Approved By: Date: <br />