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FIREPLACES <br /> �7i Gas factory fireplace <br /> Wood burning factory fireplace with flue <br /> Wood Stove <br /> Wood stove with flue <br /> BrandName l_.c.v (��X ModelNo. ���l� � � � �V J� <br /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfin <br /> No. Other Fans: Locations cfrn <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) <br /> Installation Removal <br /> Fuel oil: gallons underground inside outside <br /> LP Gas: gallons <br /> Other Gas opening <br /> PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* ar Minimum Fee ($35.00) �7,r� o� <br /> ��%�)(1 x .0125 $ � /C1 <br /> �. (contract price) <br /> 2. State Surchar�e. ** Add the State Building Code Division �-'C� <br /> Surcharge to each perinit. x .0005 $ • =� <br /> or $.50, whichever is greater (contract price) - <br /> >> 3. Postage and Handlin� (Only mail-in applications) $ _ 1.50 _ <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ ')C'� �L� - <br /> zY * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted <br /> work including materials,labor,profit,and other fixed costs. It is the amount to be chazged to the customer <br /> f� for the work done. If any material,equipment, labor, or instaliation aze fumished by the owner, tenant or <br /> �� any other party the reasonable market value of such items must be added to the estimated cost or contract <br /> price for permit fee purposes. In the event that there is a dispute on the amount of the job cost,the City may <br /> request the submission of a signed copy of the actual contract. <br /> ** The STATE SURCHARGE is .0005 of the contract price under$1,000,000 or $.50 -whichever is greatere <br /> For valuations over$1,000,000 call the Department of Inspectional Services for the price. <br /> --�s The undersigned hereby applies to the �i�y far issuanc� :;�a :��e�:��:i��� P��znit, agrees to do all <br /> work in strict accordance with the ordinances of the City and the regulations of the Minnesota <br /> �: State Building Code, and certifies that all statements made on this application are complete, true <br /> and correct. _ <br /> Applicant's Signature: <br /> ' � ',/1�.�,....-�"`._ Date: j � 47 <br /> Approved By: Date: <br /> �''' . , ..,. ��r..y�"�r�<'� '�.�����r��+,4'-.;.��„3t,•.�"���,,�r,����� .. . . .. .. e��'�t'�`�;t��i1�����' ',�.���.�, `,'��`�'.�'�'K`�,r:�`�-; , mv�.:.. . :. <br />