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WOCKI stove with flue <br /> Wood combination of add-oiu <br /> e Factory fireplace with flue <br /> Factory Fireplace (s) Frtsestandiug Masonry <br /> WOW Stove (s) Franklin, other <br /> Hrapd Name /�o,4r Model No. 45 My l� <br /> Mfyr'a Min,, Ciearances, side a rear C, rain. flue dia. Io %`ems b <br /> No, Kitchen Exhaust dticted _ recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> No. Other FarLs: Lxnatioos w_ - ._ cfm <br /> EUL NIQRA" (MUST BE APPROVED BY FIRE MARSHAL,) <br /> Installation Removal <br /> Fuel oil: gallons _ underground inside outside <br /> _ LF Gas: gallons <br /> EUM—EMIALMAIM <br /> 1. 1.25% of Cctntlact- 'ce" or NHWWwm,Erg (U5,00) <br /> J/.__r) , Cr-C; x .b175 $ —�_• C�.C� <br /> (Contract pried) <br /> 2. State Sure rr " Add the State Building Cade Division <br /> Surcharge to such permit. __ x .0005 <br /> or $.50, whichever is greater (courract price) <br /> 3. Pnst�g ,and 3� ltg (only mail-in applications) $ l SQ <br /> a. TOTAL. PERMIT FEE (Add €roes 1-3 above) $ <br /> CONTRACT MCE or JOB C'OS'T starts tilt actual or ettlmued dollar arnutwt charged for the pbnnitted <br /> Work including materials, labor, profit, and other fixed coats. It is the amount to be charged to the <br /> custoswr for the work doric. if any rzLmtcdal,equiptiwnt, labor,or installation art furnished by the owner, <br /> tetuult or any outer party the rtasoiuble market value of such items must be added to the estimated coat <br /> or coturaci price: file perutit fee purposes. In the event that there is a dispute on the amount of the job cost, <br /> the City miry request the submission of a signed cagy of the actual contract- <br /> ** The STATE SURCHAIWE is .wm of tht contract price un&r S1,000,000 or 5.50 • whichever is <br /> greater. For valuatinps over S1,000.000 call the Department of tnsprztionel Serviczs for the price. <br /> The undcligned hereby applies to the City for issuance of a Mechunical Pcrmit, agrees to do <br /> all work In strict accorlance with tux ordinances of the City and the regulations of the Minnesota <br /> State Building Code, and certifies that all statements made on this application are complete, (rue <br /> and correct. <br /> f <br /> Applicant's Sigtuttur~�ri L�:-�X l[ orf 1L7 W. Dstc: <br /> Approved By: Ditte: — <br />