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�eb-09-2001 06:51am Frcm-CITY OF ORONO +9522494516 T-494 P.003/�03 �-607 <br /> . � <br /> FIREFL�CES � <br /> Gas fa�tory fireplacc <br /> � Woa�d buruirtg facivry fireplace w�th flue <br /> W ood Stove <br /> WoOd StBve witti flue <br /> Brand Name � Model No. � <br /> �TTLATION � • <br /> 1'�Io. Kitch�ra.Exhaust ducted rt:circu.lating cfm <br /> No. � Batli E�aust {must be ducted autside) cfiu <br /> No. Ottier F�ns: I,vcations cfixi <br /> FLJEL S'�'ORa E (MUST B� AFPROVEb BY FIRE MARS�iAL) <br /> IustaYlatiGn ' 12emoval <br /> l�uel ail: �� gailo�s undexground inside ovrside <br /> I,�TP Gas: gallons <br /> :Other � Gas oPeni�g <br /> �ERMIT FE�__CA�,CULATI41� <br /> I. 1.25°!o of S�.�ii[ract Price* or�VSin; um Fee �00� <br /> � c`� x .c7I25 $ �� 7�S (,� <br /> (contract price) <br /> 2. Stace urcharge. *� Add the State Bui�ding Code Division _ <br /> Surc�arge to each pezmiF.� � _ : x .(IOOS $ �, � � <br /> or $.50, whichever is gr�ater (con act price) � . <br /> 3. Posta�,e and Handline (Only mail-in applic�cions) $ 1.50 <br /> 4. TOTAL PERMTT FEE (Add lines 1-3 above) $ _� � c.��.,�� <br /> * CONTRACT PRTC�dr IOB COST means the actuai or estimated doUar amount cbarged for rhe perntiittd <br /> work including mateiials,labor,profit,and other fued costs. It is the am�unt to be chazgcd to the Custamer <br /> for tkte work do�e. If�y material, tqtiipmeat, labor,or insta)latioa are furniahed by the owner,tet�tlt or <br /> any other parry the reasonable uiarkec va�uc of such icems must be acided to che estiu�at�d cast or conuacc <br /> pricq far permit fee purposes. In the eveut thac there is a dispute oa thE,amount of the job coat,the City may <br /> request Yhe submissinn of a sigaeci eopy of the actuul contract. ' ' <br /> W'� The STATE SURCHA1tGfi is .Of)OS of the contrset price tc�der$1,4p0,pOp or $.SQ-whichever is greater. <br /> For valuations over$1,Ot)ii,00Q eali the Dep$rpuent of Inspee[ioa�t Strvices foc tha price. <br /> The undersigned hereby applies to the City for issuance of a Iv��ec�anicai FercuiC� agrees to do all <br /> work in strict aceorda.nce with the ordinances of the City and th�e regaIations of the Minne$oca <br /> Scace Building Codr, and e�r�i�'ies that all statements macie on thi.z apgiication are complete, true <br /> and correcc. <br /> . APPlicant's Signature� � Date: 2— `� G�� <br /> Approved liy: Date: <br />