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" � <br /> WOOD�BURNING EQUIPMENT — - <br /> Wood stove with flue � <br /> Wood combination or add-on ._ <br /> Factory fireplace with flue � � <br /> - Factory Fireplace (s) Freestanding Masonry � <br /> Wood Stove (s) Franklin, other � <br /> Brand Name Model No. <br /> Mfgr's Min., Clearances, side , rear , mi.n. flue dia. <br /> Total <br /> VENTILATION <br /> No, Kitchen E�aust ductecl recirculating cfm <br /> i,�u, Bath Ex�2��st (n!ust be ducted outside) �� <br /> No. Other Fans: Locations �� � <br /> . Total <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 /> l. 1.25% of Contract Price�� or 1�✓iiiiicnum �'eQ (�3�•at3) t f - �� <br /> ���c(� x .0125 $ L' <br /> (contract price) <br /> 2. State SurcharQe. ** Add the State Building�Code DiXisio�s $ <br /> Surcharge to each permit. 3� �U � � � <br /> (contract price) <br /> or $.50, whichever is greater 1.50 <br /> 3. Postage and Handlina (Only mail-in applications) � <br /> ,, T�T e T pFg.�T�T FEF_. (Add li.nes 1-3 above) � L �_��,� <br /> * COI�ITRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted <br /> work including materials, labor, profit, and other fized cosu. It is the amount to be charged to the <br /> customer for the work done. If any material, equipmenc, labor,or installation are furnished by the owner, <br /> tenant or any other party che reasonable market value of such items �ust be added to the estimated cost <br /> or contract price for permit fee purposes. In the event that there is a dispute on the amount of the job cost, <br /> the City may request the submission of a signed coPY of the actu� �°n�' <br /> ** The STATE SURCHARGE is .0005 of the contract price under �I,QOO,Q00 or 5.50 - whichever u <br /> greater. For valuations over $1,000,00� call the DePart�ent of Inspec-tional Services ior the price. <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do <br /> all wark in strict accordance with the ordinances of the City and the regulations of the Minnesota <br /> State Building Code, and cert�es that all state made on this application are complete, true <br /> and correct --- --- 1 <br /> . - �4 a �h/1(/t�.-.- Date: �7 ���a I <br /> .._ ��l <br /> _ Applicant's Signature: <br /> Date: <br /> Approved By: ' <br />