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� <br /> , ' � <br /> FIREPLACES �� (��`^'� <br /> � l <br /> Gas factory fireplace / <br /> Wood burning factory fireplace with flue <br /> Wood Stove <br /> Wood stove with flue <br /> Brand Name Model No. <br /> VENTILATION <br /> No. � Kitchen E�aust � ducted recirculating cfm <br /> No. �_ Bath E�aust (must be ducted outside) cfm <br /> No. Other Fans: Locations �� <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) <br /> Installation Removal <br /> Fuel oil: gallons underground inside outside <br /> LP Gas: gallons <br /> Other Gas opening <br /> PERt�1IT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br /> L / �v�} - x .0125 $ <br /> (contract price) <br /> 2. State Surchar�e. ** Add the State Building.Code,Division <br /> Surcharge to each permit. ` x .0005 $ <br /> or $.50, whichever is greater (contract price) <br /> .. ' . � �>....• •�yY[L1I[K<N�1��� . <br /> 3. Postage and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ <br /> * CONTRACT PRICE or JOB COST means the actual or estunated dollar amount charged for the permitted <br /> � work including materials,labor,profit, and other fixed costs. It is the amount to be charged to the customer <br /> for the work done. If any material, equipment; labor, or u�stallation are fumished by the owner, tenant or <br /> any other party the reasonable market value of such items must be added to the estimated cost or contract <br /> price for permit fee purposes. In the event that there is a dispute on the amount of the job cost,the City may <br /> request the submission of a signed copy of the actual contract. <br /> ** The STATE SURCHARGE is .0005 of the contract price under$1,000,000 or $.50 -whichever is greater. <br /> For valuations over $1,000,000 call the Department of Inspectional Services for the price. <br /> � The undersigned hereby applies to the City for issuance of a Mechanical Pernut, agrees to do all <br /> work in strict accordance with the ordinances of the Ciry and the regulations of the Miruiesota <br /> ` ' State`Building Eode; and-certifies that all statements made on this application are complete, true <br /> . . � . .y�;.._- . <br /> and correct. _ _ <br /> � <br /> Applicant's Signature: . , � Date: � o�c' .S l`- <br /> Approved By: Date: <br />