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t , �, <br /> ��OI� ��t�� ��L�Il�NT <br /> Wood stove with flue <br /> Vijood cambination or add-on � <br /> Factory f replace with flue <br /> Factory Fireplace {s) �reesianding fi�Iasonry <br /> �'ood Stove {s j �ranklin, other <br /> Brand Name Model No. <br /> Mf�r's Min., Clearances, side , rear , min. flue dia. <br /> Tatal <br /> �l�t�'II.A�'��N <br /> No. 3Kitchen Exhaust ducted recirculating cfm <br /> No. �ath E�aust (must be ducted out�ide) cfm <br /> No. �ther rans: Lncatitrns cfm <br /> T�ta�i <br /> F�LT�I. SB'���E (NIUST ?3E APPROVED BY FIRE 1l�ARSHAL) <br /> Installation Removal <br /> Fuel oiL• gallon� underground inside outside <br /> LP Gas: � gallons <br /> Other Gas opening <br /> �E��I�' �� ��C��TIOI�T <br /> l. 1.25�o of Cortract Price* or M=�i,��a� F�� ��35.00) <br /> � ��"3 5 x .012�; � �'� . 1 9 <br /> (contract price) <br /> 2. State Surchar�e. ** Add the State Buildin� Code Division <br /> Surcharge to each permif. � �7� �S x .00OS $ � • �� <br /> (contract price) <br /> or $.50, whichever is greater <br /> 3. - Posta�e and Handlin7 (Only mail-in applications) $ 1.5� <br /> 4. TOTAL PERMIT FEE {Add lines 1-3 above) $ �j'q . �-I c�, <br /> * CONTR.ACT PRICE or JaB COST means the acival or estimaterl dollar amount charged ror tlle perm�tted <br /> work including materials, labor, profit, and other fixed cosis. It is the amount to be charge� to the <br /> customer for the work done. If any material, equipment, labor, or installation are fumished by the owner, <br /> tea:nt or any orher party rhe reasonahie r�..arket value of such items zaast be added to the estis�ated cost <br /> or contract price for germit fe� purposes. In the event that there is a dispute on the amount of the job cost, <br /> the r'iry may request the submission of a signed copy of the acnial contract. <br /> �* The STATE SURCHARGE is .0005 of the contract price under $1,000,000 or $.SD - whichever is <br /> greater. For valuations over �1,OOO,d00 call the Department of Inspectional Services ior the price. <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do <br /> all wark in strict accordance with:he ordinances of the Ciry and the regulations of the Minnesota <br /> State Buiiding Code, a.nd certifies that all statements made on this application are compleie, trae <br /> and carrect. <br /> , <br /> Ag�iicant's Sianature: % <br /> �"�.�_ Date: � 5 G k: <br /> ��t. <br /> ?.p�roved�y: Date: � <br /> __ / <br />