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`VOOD BtiR_.��'G EQLTIP�'fENT <br /> �Vood stove with flue <br /> Wood combination or add-on <br /> Factory fireplace with flue Maso <br /> Factory Fireplace (s) Freestanding �Y <br /> �Vood Stove (s) Franklin, other <br /> Brand�Tame Model No. <br /> �ifar's ti•Sin., Clearances, side , rear , min• flue dia. <br /> VENTIL:�TION <br /> �o_ �_ Kitchen Exhaust ducted recirculatin� cfrn <br /> �o. `� Bath Exhaust (must be ducted outside) �� cfm <br /> �o. �_ Other Fans: Locations �t��P Y <br /> FUEL STOR�.GE (MUST 3E APPROVED BY FIRE MARSHAL) <br /> Installation Removal <br /> Fuel oil: gallons underground inside outside <br /> LP Gas: jallons <br /> Other Gas opening <br /> pERIVIIT FEE CALCULATION <br /> 1, 1.25 90 of Contract Price* or �Iinimum Fee ($35.00)X 0125 � y 3� ' a� <br /> ��, �JC7 � OU <br /> (contract price) <br /> 2. State Surcharae. ** Add the State Building Code Division <br /> Surchar�e to each permit. �,i•� � ��D • O� x .0005 $ 1�1� aS <br /> or 5.�0, whichever is greater (contract price) <br /> 3, PostaQe and Handlin� (Only mail-in applications) � <br /> 1.50 <br /> 4. TOT�I. PERMIT FEE (Add lines 1-3 above) � � �U • �`� <br /> * CO'ITRACT PRICE or JOB COST means the acrual or estimated doliar amount charged for the permitted <br /> work including materials, labor, profi[, and other fixed costs. It is the amount to be charged to the <br /> cuscomer fui iiie woik dane. IE�y mut�rial, equipment, labc:, o:i�stalla�ion�'e fu=n��hed by rhe owner, <br /> tenanc or any other party the reasonable market value of such icems must be added to the estimated cost <br /> or concract price for permit fee purposes. In the event that there is a dispute on the amount of the job cost, <br /> the Ciry may request the submission of a signed copy of the actual con[ract. <br /> *� T:e ST�For valnat o�over1S1,000'000 callcthetDepartmen[nof Inspe�COonal�Servi es �for helpnceer is <br /> oreacer. <br /> The undersianed hereby applies to the Ciry for issuance of a Mechanical Permit, agrees to do <br /> all work in strict accordance with the ordinances of the Ciry and the regulations of the Minnesota <br /> State Buildin� Code, and certifies that all statements made on this application are complete, true <br /> and correct. <br /> � Q �� Date: I—o���`OU <br /> Applicant's Sianature;/�'�� , � , , p — . <br /> � <br /> Approved By: <.._�-�(� �1n.�y-`.- _ <br /> Date: � " '�' '�`� <br />