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.. � � v� v�wn.. � VIGG�f7YVIV IG/V7/77 1.7.GG 1,1' .W/VJ IYV.G14 <br /> • - t � � � � � , , � <br /> . `. . .li.J+��►-�5[�esfV��t� a <br /> . . . __._... Waod stovc with flue <br /> � . Wuod cc>mbination or add-on .� <br /> . ` � Faccory fii•eplacc wich �lue . <br /> - Factory Fiz�eplace (s) � I�rc�estandin� Masonry 1 <br /> . Wcxxi Stove (s) Franklin, othcr <br /> �� � Brancl Natne Model No. <br /> � . Mf�r'c Min., Clearanr.ts, sid� . rcar , min. tlue dia. <br /> � . ����1� , � . , <br /> No. KitCh�n Ezhau.4i d�crrJ reeirculuing cfm <br /> . N�. _,,� �ath F.xhaust (must be ducte� nu��ide) cftti <br /> No. Uthec Fans: I.ocatidn5 _ cf� <br /> \ ���;��� GE ,(MI1S'T H� APPROV�U BY FIRE MARSHAL) <br /> instaliAtian Removal <br /> Fuei oil: v� gallor�s underground � inside outside <br /> � 1.P Gas: gallons <br /> C�ther Gas openiag <br /> �,�.h#IT �EE Ct�CE3��'�I_ON <br /> 1. 1.25 yo of' �i�nt�ct Pr�ce* or �e� ($35��1 . <br /> ,, x .oizs $ �3..>:- 'O� <br /> f�Ontract price).. <br /> Z: St'�te Sur�h��r��. ** Add the State ��tilding Cade Division <br /> ` Surcharge to eac;h parmit_ �.�l�,����----- X •�5. $ .=--�==--u-E�—�-- <br /> - ��r �.gU, whichevcr is gre�f�r (conuaci pricej <br /> 3: �osta��.d',�Ir���lliz�� (Qr�ly mai��in apgtications) $ , - t, a <br /> 4. TOT'AL. PEI2MI`T FEE (Ac�d lineS 1-3 �bove) $ ��-�,��....._ <br /> * CON'fRAC'f PR1C£ar JOB COST cneanY the actuxl or estimaied dollt�r amount charged for che petmitted <br /> u+�rk inctuding r�atcriala, )sbor,:prnfit, and �theT fixcd cosis. Ic is t}i� aroount tn bt c�uged to the <br /> cu�u�s�ec for�hz werk dc�ne. lf nny materia�..e�lPment, �abor. or in�[altation are furxuslied hy the owner. <br /> tenutt ar any oth�� party the rcasonable market va{ue of such items mu�t be added to ttt��ttimattcL cos�. <br /> ar.^.ou�rucl�nr�cf for�+c�:nit fee pu.�xrsts.: T�the ev�t:.h:u�,et� is a dispute oa th� arntwat of the joE:ms:, <br /> � the City may rec�nest nc� submission of a s�gned cop}r nf the actuaf :conuact. <br /> ' � `•' ThC SY'A�'E SURCt�IARGE is .GOt)S af ttia contract prict undtc S1.00U,000 or S.5(1 -whichever is <br /> graatcr.: For valu�tions over 51,000.000 call the Depa�rement c+P lnspecrionat 5ervices.for ch�pric�. <br /> � , � � `7�e ut�derxigned h�reby app}ies to the City for iysuance of a Mechanic�l Permit, agrces to da <br /> � • � a!1 w��rk in strict�ccordance with the ordinan�es of the City �nd the regulations of the Minnesota <br /> . . . St�tc: Auilding Cade, ancl cerrifirs that a11 stacements tnadc; on thiS �pplication ate com�leEe; truc <br /> � . . aruf c4necC. <br /> ' � � n�: � /�� � �� � �� <br /> . . . . Applscuit s Stgnaturc; _ <br /> . . APPc��ved Ay: _ ._ �� Datc: . <br />