Laserfiche WebLink
r ;. <br /> WOOD BURNING EQ�MEN—T <br /> Wood stove with flue <br /> � Wood combination or add-on <br /> Factory fuePlace with flue Masonry <br /> Fire lace (s) � Freestanding _ <br /> Factory P Franklin, o�er <br /> — Wood Stove (s) — ModelNo. <br /> BrandName , rear _� �• flue dia. <br /> Mfgr's Min•, Clearances, sid� _ To�r_ <br /> vEN'I'ILATION recirculating �� <br /> Kitchen Exhaust _ ducted _ �� <br /> No. _ — cfm <br /> No. _____ Ba� E�aust (must be ducted outside — <br /> No. _ Other Fans: Locations Total__. <br /> L STORAGE (MUST BE APPROVED BY FIRE MA�SHAL) <br /> �E Removal ou._:ide <br /> Installation _ underground _ inside _ <br /> — Fuel oil: _ Sallons _ <br /> — LP Gas: _ gallons _ Gas opening <br /> — Other <br /> ,-.r,,� � T �rr,ATION <br /> Y��Cl'VYi'f r�.,� .,�'1. �.,� <br /> 1, 1.25% of Contract Price* or �viin�um �ee (��S•�� X 1.25 � � �� ' � �� } — <br /> (contract price <br /> Code Division _ <br /> 2, State Surchar�e. ** Add the State Building X _pp05 $ � <br /> Surcharge to each permit• <br /> (contract price) $ - 1.50 <br /> mail-in applications) � <br /> 3. p��ra¢e and Handlin� (��Y 6.��: .;_ -_� � � �� <br /> Add lines 1-3 above) � ;. <br /> 4. TOTAL PERMIT FEE ( _ ---__ <br /> ed for the permitted <br /> or estimated dollar amount charg ed to the <br /> * CONTRACT P�CE or JOB COST means tlie actual �e owner, <br /> materials, labor, profit, and other fized costs. It is the amount to be charg <br /> work including material, equipment, labor,or installation are furnished by <br /> customer for the work done. If any ob�ost, <br /> tenant or any other party <br /> the reasonable market value of such items must be added to the estimat �S <br /> r contract price for permit fee purposes. In the event that there is a dispute on the amount of the J <br /> u;e �;ty *T�ay request the submission of a signed coPY °f�e actual contract• <br /> rice under $1,�,� �r �•50 - w�chever is <br /> 5 of the contract p rice. <br /> ** The STATE SURCHARGE is •� ��1 �e Department of Inspectional Seraices for the P <br /> greater. For valuations over $1,000,00� agrees to do <br /> a lies to the City for issuance of a Mechanical Permit, <br /> The undersigned hereby pP lete, tnie <br /> all work in s <br /> uict accordance with the ordinances of the City and th aregu a�n a°f omP�eso <br /> State Building Code, and certifies that all statements made on PP <br /> and correct. , <br /> _ � -��\ � . - Date: �,_ �� J-`.- ',, \ <br /> . , ., <br /> P,pplicant's SignatuIe: <br /> �� \��. .,_ _ ;.. <br /> Date: <br /> ppproved By: <br />