Laserfiche WebLink
, �.LbC_SL��L4u•�.!l1.�Z_4''cti[��.�����1.� <br /> Wooc.i stove with flue <br /> --- .._- Woud combii�atio�n or add-on <br /> �� Factory fireplace with t7ue <br /> �__ Factory Fircplace {s) �___ Freestanding ^ Masonry <br /> Wooci Stove (s) Franklin, other <br /> Hr'�nci Name Model No. —...._. <br /> Mfgr's Miti., �"l�ai�anc;cs,';side ` re�u , min. t7ue dia. <br /> Y�NTti.Q�.� <br /> Nu. Kitchen �.x:haust ducted recircufating _ efm <br /> No. �_ Bai}i lxhaust (must be ducted ouiside) �frn <br /> N��. _4 ! C}th�� Fans: Locatians �'���_, �, �c� - � cfm <br /> � ./ <br /> �'()�'J, S'TUKAGE (MtJS1' B�' APPROVF?D BY TTR� MARS��AI.) <br /> Installatiun Removal <br /> _ Fuel oil:T " gallons __ underground � inside outside <br /> ._____ LP Ggs: __�� galluns <br /> .�----- Other ��---^---_ __.,._ Gas ogening <br /> P�'1 ;, ;. , '�I.�t1LA��1S?� <br /> 1. 1.253� of Can�ra�t Yrice* �or �Zi�(tnurn �'�e (S3S.04) <br /> — 1 , "_ x .Q2?5 $ � 1 �� <br /> `��=`'� 1 <br /> (contract price)� <br /> 2. �t�t� S�rc:ha�r� ** Add the State Building Ccx1e Division <br /> SurchHrgc to each pennit. I y.c��_ �- _ x .00US $ �� �,�.> <br /> or $.S0, whichever is greater {conuaac price) <br /> 3. �i�a �and �ia� 1� (Onty mail-in applications} $ __ -_ <br /> 4. TOTAL YERMIT FEE I;Add lines 1-�3 above) $ �` <br /> " CONTR.4CT f'ftlt'E or JOB COS'7'me� tba actwsl or eatimatrd dolJar nmc�unt charged foc che permietcd <br /> work iucluding mattrials, labor, proftt, and other fizcd costs. It is thc amount to be char�ed to thc <br /> custorncr Por the w�rk d�nc. !f�try m.lterial, equipmcnt, latx,r, or installution ruc furniahed by �he �wncr, <br /> tenant or uny �ther putry thc rcasunah�e market value uf such iterru must ve aclded to the estimated cost <br /> or contrict prtcc for pen»it fec purpvses. In the evtnt thut there is u disputc on thc amount of thc job cost, <br /> �hc Ciry may requase thr submission of a sfgncd cUpy of the actoul coutracc. <br /> �* 'The STAT� SURCHARGC is .c�5 uf the contract prict under �l,OW,()(?() or S.Sc) . whichcver is <br /> grentcr. Fot valuations ovcr SI,C�Q0,Q�0 �all the D�pariment of Iuspt�:tiuntil Servic:es for tht price. <br /> The undersigned hercby aPplies tc� che City for issuanCc of a Mechani�al Pennit, agrces to au <br /> ali work in strict accordaru;e with che ordinant:es of the Ciry anci the regulaei�ns of the Minnesota <br /> Statc Buitding Code, �uui certifies that all st�tements made on this application are romplcte, true <br /> and correct. <br /> , <br /> � <br /> -� <br /> Appiicant's Signattu�e: _ ��_�–�c�t, ����:�- r..,�:�, �___.____�.� Date: � � a a `� <br /> �. <br /> Approveci AY: Date: <br />