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� <br /> ! <br /> �VOOD BL�R��G EQiJIP��i�I' <br /> �Vood stove with flue <br /> �ood combination or add-on <br /> Factory fireplace with flue <br /> Factory Fireplace (s) Freestanding Masonry <br /> `Vood Stove (s) Franklin, other <br /> Brand Name Model No. <br /> Mf�r's y1in., Clearances, side , rear , min• flue dia. <br /> VENTIL�TION <br /> No. Kitchen Exhaust ducted recirculatin� cfrn <br /> No. Bath Exhaust (must be ducted outside) �� <br /> No. Other Fans: Locations __ cfm <br /> FLTEL STOR�,GE (�iUST BE APPROVED BY FIRE MARSHAL) <br /> Installation Removal <br /> Fuel oil: �allons underground inside outside <br /> LP Gas: gallons <br /> Other Gas opening <br /> PERIVIIT FEE CALCULATION <br /> 1. 1.2�90 of Contract Price* or Minimum Fee ($3�.001 , _ �- <br /> .-� ,�w��_ x .0125 � � `%. <br /> � <br /> (contract pnce) <br /> ? State Surcharae. ** Add the State Buildin� Code Division �, <br /> ' G� x .0005 � ` �� <br /> Surchar�e to each permit. -�I`�: <br /> or 5.50, whichever is greater (contract price) <br /> 3, PoscaQe and Handlin� (Only mail-in applications) $ 1.50 <br /> 4, TOTAL PERMIT FEE (Add lines 1-3 above) � J�7 �-� � �' � � <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the perm.itted <br /> work includin� materials, labor, profit, and other fixed costs. Ic is the amount to be charged to the <br /> customer ior tne work done. if any material, Z:iiii�:uc�t, 13DOI', v:i:;:3�I:::1CIl 2S? fi��chP��iy t�le owner, <br /> tenant 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 the submission of a signed copy of the actuai contract. <br /> ** T::e ST:�TE SliRCH:�RGE is .000� of the contract price under S1,000,000 or 5.50 - whichever is <br /> o-ea�er. For valuations over S1,000,000 call the Departmen[ oi Irspectional Services for the price. <br /> The unde:siQned hereby applies to the Ciry for issuance of a �fechanical Permit, agrees to do <br /> all work in strict accordance with the ordinances of the City and the re�ulations of the Minnesota <br /> State Building Code, and certifies that all statements made on th.is application are complete, true <br /> and correct. <br /> r� , � �7 <br /> Date: � ( <br /> Applicant'sSignature: �� '� �� . <br /> roved B : Date: [V — � � �� <br /> �,pp y . <br />