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.{ , � <br /> FIREPLACES , ,�. <br /> � <br /> Gas factory fireplace �j 1` � <br /> Wood burning factory fireplace with flue I �, l(� <br /> Wood Stove � <br /> Wood stove with flue '�� <br /> Brand Name Model No. <br /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating cfin <br /> No. �_ Bath Exhaust (must be du ted outside) cfin <br /> No. �_ Other Fans: Locations ^ .�;/� �2.� �� <br /> FUEL STORAGE (MUST BE APPROVE _ BY FIRE MARSHAL) <br /> Installation Remo -- <br /> Fuel oil: gallons undergrou inside outside <br /> LP Gas• gallons <br /> O r Gas opening <br /> � <br /> PERIVIIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee 35.00 <br /> C`-�`�- � x .0125 $ <br /> (contract price) <br /> 2. State Surchar�e. ** Add the State Building.Code_Division - <br /> Surcharge to each perniit. ` x :0005 $ <br /> or $.50, whichever is greater (contract price) <br /> . . . ' w,....f�Vr��Mr sNiYel�r 1Ar� . <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 estimated 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 uistallation 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 Ciry for issuance of a Mechanical Pernut, agrees to do all <br /> work in strict accordance witYi the ordinances of the City and the regulations of the Muinesota <br /> ` `State�Building Code� and certifies that all statements made_on this application are complete, true <br /> and correct. <br /> A licant's Signature: , ���\��� � Date: I I `� (� �L ^: <br /> rr <br /> Approved By: Date: <br />