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WOOD B Y2N�NG E4IJ�PNi��1T <br /> . Wood stove with flue <br /> Wooa combination or add-on <br /> Factory fireplace with flue <br /> ractory Fire�lace (s} Freestanding _ Masorv�y <br /> Wflod Stove (s) Fraia.klin, other <br /> Brand Name �vf�del No. <br /> Mfgr's Niiii., Ctearanccs, srde , rear_ , min. flue dia. _. <br /> VTNTILATION <br /> No. Kitchen Lxl�aust ducted recirculating cfm <br /> No. �_ Bath Exhaust (must be ducted outside) cfm <br /> No. Other Fans: Locations cfm <br /> FIJET� STC7R.AGE {MUST BE APPROVED BX FI�tE 1V�ARSHAL) <br /> Installation Femoval <br /> �'uel oil: galions uz�derground inside outside <br /> LP Gas: gallons � <br /> OEher _ Gas 4�ening � <br /> PERMIT k'�E CAL(�ULATION = <br /> 1. 1.25% of Contract Price* or �,Vlinimum Fee (�35.�0) ' <br /> -�o o, E�> X .o�2s $ G�, �-ie ' <br /> {contract price) <br /> 2. State Surehar�e. ** Add tl�e State Building Cude Division a <br /> Surcharge to each. permit. x .00QS $ ��' �' �� - r� <br /> or $.50, whichever is greaner (co�itract price) `� <br /> , <br /> u <br /> 3. Posta�e az�d Handlin� (Only maII-in applicatxans) $ ;. 0 — � <br /> 4, TOTAL PERMIT rEE (Aad lines I-3 above) $ f- �,� I f� <br /> i <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dotlar amuunt char�ed for the permitted � <br /> work including materials, labor, profit, and other fixed costs. �t is the amount to be chargcd to the ' <br /> i <br /> customer for the work done. If atty material, equipment, labor, ar installation are furnished by the owner, � <br /> tenant ar any �ther party the reaaonable market vaiue of such items must be added to the estimated cost " <br /> or contract price for permit fee purposes. In the eveat that there is a disgute on the amount of ihc job cost, , <br /> the City may request the subu�issian of a signed copy of the actual contraet. <br /> "`* The STATE SU�tCHARGE is .0005 af the contract price under $i,Q00,000 vr �.50 - whichever is � <br /> �reater. �or valuations over �1.000,000 call the Department of Inspectional Scrvices for the price. ; <br /> � <br /> The undersigned hereby a�plies to the City for issuance of a IV�echaiucal Permit, agrees to do <br /> all work in strict accordance with the ordinances of the City and the regulations af the Minnesota <br /> State Building Code, and certifies that all statements made on this application are complete, t.t'ue <br /> and correct. <br /> , <br /> Applicant's Signature: � / ���--�J Date: .`-�/o�—Y�� <br /> Approved By: Date: `�— 0 <br />