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, . _ . <br /> • <br /> 9V iJ�3J L'V�� ��,(�'iJLl4nn'�� <br /> Woc�a stove with flue <br /> Wood combination or adci-on <br /> Factory fueplace witii flue <br /> �actory �ireplace (s) �re�sianciing Ivlasonry <br /> W'ood Stove (s j i ranklin, other <br /> Bra�d Name Model No. <br /> IvlfQr's Iv�in., Ciearances, side , rear , min. flue dia. <br /> Total <br /> �1�'�'�A�'I�?�t <br /> No. Kitchen E;haust dueted recirculating cfm <br /> No. �ath E;.�aust (musz be ducted out�ide) cfin <br /> No. �ther Fans: Locatians cfin <br /> 'a'otaf <br /> �'IJ�L ST�kgAGE (ivIUST BE A�'PROVED B�' FIRE MARSHAL} <br /> Installation Removal <br /> Fuel oiL• gallon.s underground inside outside <br /> LP C�as: gallons <br /> Other Gas opening <br /> ����I'�' F�� C�I.ICUI.ATI�I� <br /> l. 1.25% of Cortract Price* or i�=�i��a€� ��� ��35,G�) <br /> `1 ��5 x .ol2s � �2 . 3 � <br /> (contract price) <br /> 2. State Surchar�e. ** Add the �tate Building Code Division <br /> Surchar�e to each permit. �-t �v S x .00�S $ 2 • `'� `� <br /> (contract price) <br /> or $.50, whichever is greater <br /> 3. Postage and Handling (Only mail-in applications} $ 1.50 <br /> 4. TOTAL PERMIT FEE {Add lines 1-3 above) $ l� (�, , �3� <br /> CONTRACT PRICE or 3d�COST means the actual or estimated dollar amount charged tor the permitted <br /> work including materials, labor, proiit, and other fixed costs. It is the amount to be charge� tn the <br /> customer for the work done. If any material, eauioment, labor, or installation are fumished by the owner, <br /> tenant or any other party the reasonable market value oi such items must be added to the estimated cost <br /> �r�rJntrgr( n,-;�P t'�,r ner_mit fee nurooses. In the event that there is a dispute on the amount of the,job cost, <br /> r <br /> the Ciry may request the submission of a signed copy of the actual contract. <br /> ** The STATE SURCHARGE is .0005 af the contract price under �SI,Oa0,000 or $.50 - whichever is <br /> greacer. For vaivations over $1,000,000 call the Department af Inspectional Services for the price. <br /> The undersigned hereby applies to che City for issuance of a Mechanical Permit, agrees to da <br /> all work in strict accordance with the ordinan�es of the City and the regulations of the Mi.�.nesota <br /> State Buiiding Code, and cert�es that all statements made on this appiication are complete, true <br /> and correct. -� <br /> 1 �!�g�lica�t's Signature: Date: � Z`-1 G� <br /> ��� <br /> ?apt�roved�y: Date: <br />