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s <br /> a <br /> �VOOD BLR.ti`Li�'G EQLTLPtiLE`I'r <br /> `Vood stove with flue <br /> Wood combination or add-on <br /> Factory fireplace with flue Maso <br /> Factory Fireplace (s) Freestandin� �' <br /> �ood Stove (s) Franklin, other <br /> Model No. <br /> Brand�Tame min, flue dia. <br /> �1far's �iin., Clearances, side , rear , <br /> VENTIL�TION <br /> No. % Kitchen Exhaust % ducted recirculating �� �- cfm <br /> No. �_ Bath Exhaust (must be ducted outside) -- `'- �� c� <br /> �jp. OLher Fans: Locations ______ <br /> FUEL STOR�,GE (MUST BE APPROVED BY FIRE MARSHAL) <br /> Installation Removal <br /> Fuel oil: �allons underground inside outside <br /> LP Gas: gallons <br /> Other Gas opening <br /> pERi'VIIT FEE CALCULATION <br /> 1. 1.25 0 of Contract Price�` or Minimum Fee $35.00 <br /> `G1��, Q� x .0125 � <br /> (contract price) <br /> 2. State SurcharQe. ** Add the State Buildin; Code Division <br /> Surc:�arge to each permit. x .000� � <br /> or 5.�0, whichever is greater (contract pnce) <br /> 3. Postaae and Handlina (Only mail-in applications) � <br /> 1.50 <br /> 4, TOT?�I. PERMIT FEE (Add lines 1-3 above) � <br /> * CO`TRACT PRICE or JOB COST means the acrual or estimated dollar amount charged for the permi[ted <br /> work including macerials, labor, profit, and other fixed costs. Ic is the amount to be charged to the <br /> customer for the work done. If any material, equipment, labor, or�installa:ion are furnished by the owner, <br /> teaant or any ocher Part}' the reasonable marke� value of such items must be added to the estimated cost <br /> or concract price for permit fee purposes. In the event that chere is a dispute on the amount of the job cost, <br /> t}e C:ty may request the submission of a signed copy of the actual concract. <br /> ** T.:e STATE SURCH:�RGE is .000� oi the contract price under 51,000,000 or 5.50 - whichever is <br /> o_ea:e:. For valuations over S1,000,000 call the Deoartment of Inspectional Services for the price. <br /> The unde:siQned hereby applies to the Ciry for issuance of a i�iechanical P�f�e�e�°o <br /> all work in strict accordance with the ordinances of the Ciry and the regulatio <br /> State Buildi.n� Code, and certifies that all statements made on this application are complete, tnie <br /> and corrert_ , > <br /> < � Date: - <br /> Applicant's Signature . <br /> ved B : C� �` Date: �' ( `�� <br /> Appro Y <br /> I <br />