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r <br /> woo B E u� NT <br /> Woc�d stove with flue <br /> Waod combination or add-on <br /> Factory fueplacc with flue <br /> Factory Fireplace (s) Freestanding Iv�asonry <br /> Wood Stove (s) Fran(clin, other <br /> Brand Name Model No. <br /> Mfgr's Iv�in,, Clearanccs, side , rear , min. flue dia, <br /> Total <br /> � IL TIO <br /> No. Kitchen �xhaust ducted recircuiating cfm <br /> Na. Bath F,xhaust (must he ducted outside) cfm Cfm <br /> Np, Other Fans: Locaiions <br /> Total <br /> �j_, ' O E (MUST B� APPR�VED AY FIRE MARSI-�AL) <br /> Installation Rcmoval <br /> Fuel oil: gallons underground inside autside <br /> LP Gas: gallons <br /> . Other Gas opening <br /> TT FEE UL T <br /> �, 1.25% of Conl�act r' e* or Minim m F�e (S35.00) <br /> ���L �,r.'. .3�2"-- x .0125 � _ �s. � <br /> -'/ (aintrect PT1CC) <br /> 2. State Surch�_r�,_ '"* Add the State Building`3C�c Division �' � <br /> Sur�harge to each permit. �'�, '7 � . x .0005 $ /�.� <br /> � (contract Pricc) <br /> or �.50, whichevcr is greater <br /> 3, Pos�t �e and H n�d1�i�S (Only mail-in applications) $ _ 1.50 — <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) � <br /> * CONTRACT PRICE or JOB C�ST means the uctual pt estimatcd�ollar emoune cberged for the permitteci <br /> wotk including matcrials, labor, profit, and other fuod costs. It is the amount to bc charB�d to the <br /> customer for che work done. If any matcrial, cquipawnc,labor,or installation are furnished by the owner. <br /> tenant or eny other party tho reasonable market valae of suc6 ite�ns must be added to the estimated cost <br /> or wntract price for permit fa purposcs. [n the evwt that�here is a disputc on the amount of the Job cost, <br /> the Ciry may reqaest th�a�bmission of a signed copy of the aetusl contracc. <br /> *+ 7-t�e 5'i'A'I'E SURCI-IARGE Is ,0005 of the wntract price ur.der 51,000,000 or 5.50 - whichevec is <br /> greater. For valuations over 51,000,000 csll the IlePartmen[ of lns�ec[ional Services for the ptice. <br /> The undetsigned hereby applies to the City for issuance of a Mechanical Permic, agrees to do <br /> all work in strict accordance with thc ordinances of the City and the regulations of the Minnesota <br /> St�te Build'u1g Code, and certifics that all sWtemencs made on this application are compietc,true <br /> and correct. � � • <br /> '� � ��� - n � <br /> Applicant's Signature: C�C� '� Date: <br /> Date: � '�`�' <br /> Approved By• y <br />