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. � <br /> ��'.�.����Z N�'.�_�'i�I� <br /> Wa�xi stove with flue <br /> � Woc�d combit�ation or add-vn <br /> �� Factory �re�lace with t7ue <br /> �� Fnctoty Fircplace {s) �_� Frecstanding � Mas�nry <br /> Wooc! Stove (s) Frankiin, other <br /> Hrarxi N�ne Mociel No. �!� <br /> Mfgr's Miii., Clc;aranc:rs, sidc `� rear , min. t7ue dia. <br /> Y.�NTI j.,A�N <br /> No. _____ Kitchea f:xhaust ducted recirculating efm <br /> No. _ Bat1i L;xhaust (must be ducted outside) �fm <br /> N��. __� C�ther Fans: Locatipns � Y cFm <br /> '�� � .,�:�5),�� (MUST' BF APPROVF?D BY I=IR� MARS��AI,) <br /> Installation Removal <br /> _ Fuel nil _ ga}lo�as und�rgraund _ inside _ outside <br /> �__. LP Gas: gallvns <br /> �_.__� Othrr ��__._.__ __.�... Gas ogening <br /> PE��VI�����A LJLA���� <br /> 1. 1.257 of Cnn�ra�t Prite* or �'ee �S3S.Q4) <br /> x .Ol?5 $ ' �� <br /> ��„�.- � --. _ <br /> (concracc prsaa <br /> �. �tate Surc:hargrt ** Add the S te Building Caie Divisit�n <br /> SurchNrgc to each percnit. 1ta S ��U x .(1QQS $ , � � <br /> or $.50, whichever is greacer (conereat price) <br /> 3. Po��a��,and �ia� 1� �O�iiy mail-in applizations) $ _ _ �.�p <br /> 4. TUTAL �'ERM1T FFE (Add lines 1-�3 above) $ � � �, � . <br /> * CnNTR.4CT PItIC'�or.fQB COS1'meatu the aetutil or eatimated dollar Amc�unt charged for tfie pertqittcd <br /> work iucluding materials, labor, profi�, and other fized costs. lt is thc amount to be ehar�ed to the <br /> cuutamcr fur the work�nc;. If any mnterial, equipment, labor, or u�,stallution ruG furryiahed by the owner, <br /> tenant or any ather purry the rcasonahle ivarket vrilue of such items must Ge acideci to the estunatad cost <br /> or ccatitrset prlee foc ptnz�lt fre purpoaes. In tha evtnt thut there is a dis}�ut�on the amount of�hC job eost, <br /> thc City may requase the submisaioa of a signed tapy of the actuul coUtrace. <br /> ** Tl7e STATE SL'RCHARGE is .Q005 uf the contract price undcr �1,OOU,UOO or S.SA - whichevCr is <br /> greuter. Fnr va]uQtions over S1,000,Q()0 call the DCpartrnrnt of Iuepectian�t Servic;es for the price. <br /> The undersigned hercby applirs to the City for issuanCe vf a Mechani�ai Permit, agrces to do <br /> all work iti strict accordaru;e with the vrdinanc:es of the City anci the rc�gulations of the Minnesota <br /> Statc �3uilding Code, and c�rtifits that all statements made an this application are romplete, tnic <br /> and cornct. <br /> Applicant's Signatur�.- � Date: �� �-� <br /> _ � <br /> Approveci Hy: Dau: <br />