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• �5/�'(/y.5 1�:t�b THE �'11Y UF ORLJNU 612-4`�3-7�57 ��11 <br /> -. ' <br /> woo� uxr�-nv� E��� �`' =' . <br /> T.r . <br /> ' ' WOOC� StOVe Wlt�l fltl� <br /> Wood cambination or add-on <br /> Pactory fireplace with flue <br /> racCoty Fireplace (s) �r�est�ndin� Masonry <br /> Wood Stove (s) ,� Franklin, ott�er , <br /> Brand Name Model Na, <br /> Mfgr's Min., Clearances, side , rear , min. flue dia. �_ �� <br /> Total <br /> ,�. <br /> V�NTIL,A.�'YQN <br /> No. Kitchen Bxhaust ducte� recirculating � cfm <br /> No, � Bath Exhaust (must be ductcd outside) �1`� <br /> Na. Other �'ans: I,ocations cfrn <br /> . Total <br /> L S" E (MUST BE AP�ROVED B1' P�RC MARSHAL) <br /> Tnstallation �� Remova� <br /> � Fuel oil: gallons �^ undez'ground irz�iclr outsicic <br /> LP Gas: gall�ns <br /> OihCI ._ Gas openirr� <br /> �'�RMI'�FEE C LCULA.TI�i�t <br /> 1. 1.25"Io of Contract ��ice* or Minimum Fee f$�.0,01 <br /> �ao0_ 00 X .ai�s � _ 3 S� --- <br /> � (a,ntracl price) <br /> 2, tate S � har e, ** Add the State Bui3d'u�g Code Division �� <br /> Surcharge to each �ermit. l�O • OO �: .00OS $ � <br /> (contrHc� pricc) <br /> or $.50, wh�chcvcr is greater <br /> 3. Postage and H�dIin� (Only zanail-in applications j $ 1-�� — <br /> 4, TOTAL PERMIT FE� (Add lines 1-3 above} � �• �� <br /> "� CONTRACT PRiC�or JOB CQST means Ihe actual or estimatcd dollar amount ct�argcd for the perm.itted <br /> work uicluding materials, labor, ptofit, and other fixed c4s[s. It is the aInoutu to be charged to the <br /> customer�or the woXk done. Tf a�iy matcrial, equipment, laboy, or iinstallation are furnished by the owneX, <br /> tenant or any other party the reasonabie market value of such iteius must be added to t��e estimated cost <br /> or coz�tract price for permie fee pur�pses. In the event that there is a dispute on the amaunt of the job eost, <br /> the City may rec�uest the submission of a sisned eopy of thc actual eontract. <br /> �* The STATE SURCHA�tGE is .C►pUS of the eontract pric;c uudcr $1,004,000 or S.SO - whieheve� is <br /> greater. �or valuations over $1,000,000 call the Department of Inspe:ccional Services for tk�e price. <br /> The undez'signed hexeby applies to the Cily for issuance of a Mecl�anical Pex-amit, agrecs to do <br /> alI work in strict accorda�ace with the ordinances of the City and tkie re�ulatio�s of the Mznr►esota <br /> 5kate Building Code, and certi�es that all statez�nents made on t�iis applicatio� are cvmplete, true <br /> and cbrreCt. • <br /> � W l .. D�te: s/o�'7 ( 93 <br /> Ap�hcant s S�gnaturc: - <br /> Ar�roved By: Date: <br /> ������_5/,�.�/` ; <br />