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wo <br /> Wood StOVO with 0110 <br /> Wood cOmc�CB wtiOn ith fly Freestanding <br /> �� <br /> Factory fiz p lace (s} ,,.._�. Freestanding ,,,,�,.�.. Masonry . <br /> pactory Firep Franklin, oilier __-•--- <br /> '""'� Wood stove (s) Model No. __—.�---- <br /> praDd Namemin. flue dia. <br /> Iyifgr`s Mi11.► OiearancesTo <br /> , aide near __- tal <br /> �" r � , dllRttrt'i recirculating _� cf1Zl <br /> 4 Mtehen Exhaust •- cfm <br /> No. Bath Exhaust (must b ducted outside} ----- cfnt <br /> No. ..._ ether Fans'. Locations <br /> No, <br /> , <br /> (MUST BE APPROVED 8Y r1RF, MARSHAL) <br /> WCLeinstailla6toiOn <br /> RenloYai � vtitsidc gallons <br /> under�roul�d ixisxdtr , <br /> Fuel oil: ,^...._ 8 <br /> LP Gas: ,,...,.�,. gallons Gla opening <br /> o€ Q=99D= or4M1 ( ,0125 _��- --•- <br /> �.act� <br /> Add the State Building Code, DiviSlOn ' <br /> 2, .. -� <br /> Surcharge-to each�prmit, ... �trtict <br /> or $.50, whichever is greater $ •— <br /> i g (Only mail-in applications) — f <br /> 3. $ <br /> �. TOTAL FEPNIT THEE (Add lines 1.3 above) Dunt chargCd for the po�uacd <br /> * 00NTR.ACT PRICE or JOB COST moans the actual or eatimrtitcd dollar am <br /> matvriala, lobar, profit, tuYd other fixed costs. It sial auo=�se����d by�e�vpyo�c <br /> work including mxterinl, equlpnjent, labor, or ias <br /> customer for the work dorso. If 400 <br /> other the reasanabla Market value of Duch itemsd sputo on the amount of tic job costded to cbe estiEnated , <br /> tenant or any Putt <br /> or contract price for permit fee purposes. Irl shed co ty of the AQtna1 COnEract, <br /> the City may request the sub�asiaa of a siP�' p whict,avur is <br /> kGE contMAct rte© wader $1,000-000 or $,So <br /> s+ The STATE S RC Das avpri$1,Q4o1�4Q�ali the pGp�went Af ln�pectio�tai Services for thtl price. <br /> greater. For A rgCS to d0 <br /> far issuance of a Mechanical FO-rm.it, S esota <br /> The undersiped haroby appl1es to the City ro �alations of the Minn <br /> temente wade on dis application are complete, true <br /> all work in strict aacprtnCe,with the ordinnncee of the City and b <br /> State Building Codd, and certinos that all <br /> and correct• C <br /> Dalt:; <br /> Applicamt'a S 190tu�re, <br /> . - Date: <br /> ,:�a.�.....-- <br />