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� <br /> 1 -- � � i � i �t�' i,i r i`--� , �n_i-, <br /> . <br /> '�� '(�()U B__URN_II'dG �:UUll't11LN'1� <br /> Wood slove wit�� flue <br /> Wt)Uil COil]bJ1�al1Un pr aticl•-()11 <br /> � I�aclory firepl�ice witl� (lue <br /> __ I�a�tc►t�y �ireplate� (s) _ _ .['x'GCstautfing -- M7SOItCy <br /> Worad Stave (s) �ratjklin, oilier <br /> Br�ur]Nai�te ^ Model No. <br /> Mfgr's h�1iu., C1�i1I:111C:�ti, side��, ^rear _ --► n�in. fluc dia. <br /> 'i'utal <br /> �'EI`�'I�II�A�'�UN <br /> No. Kitchc�i Lxhausl ducted _ recirculating cfin <br /> �to. T Bat1► Exh�zust (must E�e ducced out�5ide) �—__ cfr,• <br /> I'vu. Ottiet' 1�ans: L,ocatiuus cfrti <br /> ----- � 'I'ofal � <br /> + i�;t. 5'1'(7�t.�G]C (MC�S'1' B� AI'PROVE�� T3Y FIRE AZARSI�IA.T_.) <br /> � Ir�tailatiou k�m�val <br /> ^ Huel oil: � �allons uuaerground _ __ u�side outside <br /> ---_ LY (�.�as: -_—� gallons <br /> � Qtl�er __ ------------��_._.__---- --- Gas opening <br /> YGRII�IT "I;L CALC CJI� 'A i'ION <br /> 1. 1.25%a of Cot�tract Price"' or 11��ini�nucn Fee_��S S)l� __ ,. <br /> 1 � ` 1 <br /> _ ` I_-� G G� ---- x 1.25 $ =�,, C " �; i�t i r� ) <br /> (Cotltract �riC�C) <br /> 2. State Surcliarge._ ** Add �lie State �ailding Code Jaivision <br /> , �_^� <br /> Surcharge lo eacl� pet'xnit. � ^ � x .U005 g _ __ <br /> (pontract price) <br /> 3, F'osta�e at�d Haricllit� (Unly mail-in ap�7lications) $ _ 1.5 <br /> 4. T�7TAI. P�RMI'I' FLL (Add luies 1-3 above) $ '-� _:', ��. <br /> * CUN'I'RAC'I'PKI[,fs orJOB COST means thc actual or estimated dotiar�nuuut cL��;ed for the permittod <br /> ��:}C�: :G1C?l:Ca,'.T:� IT1�S:CI1:11$, :'t)U.T� �C(:I'i., i�:::� �:I�1;:C r1?:':.:� CO".iS. :� :5 !l!C. :.�L.*SUILc. !U !'G G21�i:�fM *4 1_}]C <br /> customer for tiie work done. It any material, equiptnc�t�, lab�r, or u�stallacion a�c fu�ni�hcci by �he awncr, <br /> tenant or avy c�ther pxrty the reaso»abte mart�et value of such itcu,� ,.uust be added to tt�c cstimated cost <br /> or contract price for pern�it fee Pu�poses. In il�e eveut diat tbere is e dispute on the vnount af khe job cost, <br /> tt�e City may request tbe submissiun c�i<< signed copy of tho actual contrsct. <br /> ** 1'hC 5'TATE SUItt�HAFCGE i5 .CH105 oT ttte eoutr�tct p17ce undcr $1,(300,000 c�r $.50 - whichcvcr is <br /> �ieater. Far valu2t��ns over $1,(NJD,l1()U Cafl tlie Departcue»t c�f Tnspccii��nal Services for the price. <br /> `I't�e uazQersigned hereby applies t� �ie Cily fot' issuance of a Mechanical Pennit, agrees ta do <br /> all w�t•k ui strict accordai�ce witli tlie ardici�rices of[t�e City and tlie i•egulati��ns �>f lt�e Iviituiesota <br /> Slate Building Code, artd r_ertifies that all staternents rnncl� un tlus apI?ticalian a�-e ccxnplete, true <br /> and corre�t. <br /> � , . ,�!, � �� �f�:� �' �� � �� <br /> � <br /> �p��Iicanc's Sigliature: _ � -„� `{ ,,� ` /__-- _ I.�ate -_:� � � <br /> �.� �r _ __- ---- <br /> Apprctived By: _ T _ - --- - Date: � 02 Q.� <br />