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� � <br /> �Y.�Qp atJxlvnvc_�.r �s <br /> Wo�� stove with flue <br /> Wvod c�mbii�ation or add-on <br /> �� Pactory �re�lace with flue <br /> `� Factoty Fircplace {s) �___ Freestanding � Masonry <br /> Wooci Stove (s) Franktin, other <br /> Branci Name Model No. �...._ <br /> Mfgr's Min., Gt'.iii�AJK;CS, side' � rear , min. Ylu� dia. � <br /> y�N7'IL�iTiO,'v �, �'Q-�'� <br /> No. (___ Kitchea � ciucted recirculating efm <br /> No. .�p _ Bath �a�#���ust be ductcd outside) cfm <br /> No. __L Other� Locati4ns � r cfm <br /> �,1�,5�'�,�� (MtIS1' BE APPROVED BY , KE MARS��AI,) <br /> Installation Removal <br /> _ Fuel �il� " sallons __ underground inside outside <br /> ..___. LP Gas: _�� gallvns <br /> ,------- Othrr ��------.-- ____._ Gas opening <br /> PERMTT I��;F; ��,],�C1LA,�'ln:� <br /> 1. 1.25In of Can��t Price'" ar �ifnImum�€e (�33� <br /> �1��.;, ,�. U� X .ai�s � �-�-�---- <br /> (contract pricc} <br /> �. �tat,� Surcha�� ** Acid the State Building Coe�e Divisit�n <br /> Surchargc to each per�nit. _I l.(��. �_ x .00OS $ �� � �J <br /> ar $.50, whichever is gre�ter {conueot price) � <br /> 3. Pp� ag� and Fta� lc�ig (Oniy mail-in applications} $ _ _ � <br /> 4. TOTAL E'ERMIT FEE (Add lines 1-3 above) $ 4�j�,�rj� _ <br /> " Cn1V7`RACT PftlC�pr JOB COS7'mesn�the actual vr estimated dollar um��unt charged for th� permictcd <br /> work iucluding muierials, labor, prc�ftt, and other fixed costs. lt is thc amount to be �har�ed to thc <br /> cubtomcr fur the worlc dunc. If any material, equipmcnt, tatwr, c�r autallution ruc furniahed by ehe �wner, <br /> tenant or uny�thtr putty the rea�nnah�e niarket value uf such ite�ru must Ge added eo the estimatcd cost <br /> or contrxct ptice for ptnt�lt i'�c purposes. In the event thut there is u disput� on the amount of thC job cost, <br /> ihe City may requd6t thr submission of a si�ned topy of sha actual coutrace. <br /> ** ?he STA7E SLRCHARGE is .00�5 uf the contract prict undcr 51,OQO,U(xf or 5.50 . whichever is <br /> greater. For v�luations over Sl,UQ0,4()0 �ull the D�parttntnt of Inspectiuuat Services for tht pricz. <br /> The undersigned hercby appiies tv the City for issuance of a MechanicaI Permit, agrees to c�u <br /> ali work in strir.t accordance with the ordinances of the City anci the regulations of the Minnesoca <br /> Stacc Building Code, �uxf c�rtifies that ali st�tements made on this applicetion are romplete, true <br /> and cornct. <br /> Applicant's Signatur . __ � �fl�' �-�— Date: L��� <br /> i �����4� <br /> APpm�ed By: � Dacc: i -5 - a� <br />