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FIREPLACES <br /> � Gas factory fireplace <br /> Wood burning factory fireplace with flue <br /> Wood Stove <br /> Wood stove with flue <br /> Brand Name /�Qjp,�� ��� �� �L��'L �C Model No. ��S��lS7 <br /> ��� � �A����� ��t� ���. r�i��'s � y�; c�o� <br /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> No. Otker Fans: Locaticns cfm <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 /> PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br /> � �,,�.�� x .0125 � �0-5y <br /> (contract price) <br /> 2. State Surchar�e. �`* Add the State Building Code Division <br /> Surcharge to each permit. x .0005 $ ;, (l07 <br /> or $.50, whichever is greater (contract price) <br /> 3. Postage and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �/�,(.��G <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 installation are furnished by the owner, tenant or <br /> any other parry 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 Ihere is a dispute on the amount of the job cost, the Ciry 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 Permit, agrees to do all <br /> work in strict accordance with the ordinances of the City and the regulations of the Minnesota <br /> State Building Code, and certifies that all statements made on this application are complete, true <br /> and correct. <br /> G � ,�/ <br /> Applicant's Signature: �C������CCl1 ��; Date: — ,��07�� <br /> Approved By: Date: <br />