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z . <br /> �VOOD BtiR.�'G EQL1IPl�fEN'T <br /> `�ood stove with flue <br /> Wood combination or add-on <br /> �(_ Factory fireplace with flue <br /> Factory Fireplace (s) � Freestanding Masonry <br /> �_ �ood Stove (s) Franklin, other <br /> �,i�,., ��� Model No. :�f l�5 " G V-3rv <br /> Brand Name , �',d ,�L 9'- /Z� �� <br /> �1far's ti1in., Clearances, side , rear , min. flue dia. <br /> VENTIL�TION <br /> ;.lo. Kitchen Exhaust ducted recirculatin� cfrn <br /> No, Bath Exhaust (must be ducted outside) �� <br /> No. Other Fans: Locations <br /> cfm <br /> FUEL STOR�.GE (MUST 3E APPROVED BY FIRE MARSHAL) <br /> Installation Removal <br /> Fue1 oil: gallons underground inside outside <br /> LP Gas: Qallons <br /> Other Gas opening <br /> PERIYIIT FEE CALCULATION <br /> 1. 1.25 90 of Contract Price* or Minimum Fee ($35.001� 0125 � <br /> c� <br /> �Gr��-� <br /> (contract price) <br /> 2. State Surcharae_ ** Add the State Buildin; Code Division <br /> Surchar�e to each permit. x .000� $ <br /> or 5.50, whichever is greater (concract price) <br /> 3. Postaae and Handlina (Only mail-in applications) � <br /> 1.50 <br /> 4, TOTAL PERMIT FEE (Add lines 1-3 above) � <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permicted <br /> wor}; includin� materials, labor, profit, and other fixed costs. Ic is che amount to be chareed to the <br /> cuscomer for the work done. If any material, equipment, labor, or installation are furnished by che owner, <br /> tenanc or any other parry the reasonable market value of such items must be added to the estimated cost <br /> or con[ract price for permit fee purposes. In the event that there is a dispute on the amount of the job cost, <br /> the Ciry may request che submission of a signed copy of the actuai contract. <br /> ** The STATE SURCHARGE is .000� oi the contract price unde: 51,000,000 or S.50 - whichever is <br /> oreacer. For valuations over 51,000,000 call the Department of L^.spectional Services for the price. <br /> The undersianed hereby applies to the Ciry for issuance of a �Sechanical Permit, a�rees to do <br /> all work in suict accordance with the ordinances of the City and the regulations of the Minnesota <br /> State Building Code, and certifies that all statements made on th.is application are complete, tnle <br /> and correct. <br /> ppplicant's Signature: <br /> ��� � Date: .-'-' � � � <br /> Approved By: <br /> Date: <br />