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V1 I T vr �rcvivv � o�cc�►7�tviv v�� i�rw �c.�r � .v�iv� ivv.�ci <br /> ..11�3i+fJt�lcii►Z . ' ' . � , . . <br /> . . Gaa f�:u�ry t7replacc. .. . . � <br /> � � � Wocid.bucning facfory frre�lace wit6 flue . . <br /> . � � ,WE�i�st Stove � <br /> w�a �i�v� W�a�flu� <br /> .� Drand Nam� . . � - Mculel Nn. <br /> VENf rLATION . � . � . <br /> Itifa: YCitcheri Fxhuust ducted: recircula�ing cfm � <br /> .. Na. Bath �ach�usc (must b�ducted outside) cfm , <br /> No. � Uther Funs: Locatinns cfin <br /> ,F�1�.�TO$AG� �ML1ST BE APPRUVED BY .FIRr NIARSHAI.) <br /> �lns�allatios� _ . R�nu�vft} . . <br /> I'uel oil: gallon9 underground inside autsic}e <br /> � LY CiHs: � gAIIons <br /> � Other _�T . Gas c�peiung <br /> ��A'�LtF+�S;�S�uLA'�IOi�I <br /> 1.. 1.?S% uf C�ntr�ct Pricc* or , �Q� <br /> - �� � x .ot2s � ��5 <br /> c�enu�t p����� <br /> Z �Ytc�I�,Surch:tra�: "'"Adc#the Stat uilding C�Divisi�n <br /> �urchargc to��eh permit. ��.F�� x .QOUS ' $ �',. �> <br /> or $.50, whichever is grcater (cuncrac�prlce> � <br /> � 3. t'n• gc�nd lld�Ug (nn}y mxil-in gpplications) � <br /> �.. 4 TQTAJ�T'ERMIT FE� (Add ti�ies �3$bove) $ /2�� <br /> � : ' CONTRACT PR10E or l08 COST sneans Eltc ac:taal vr rstima:sd dollaf t�rnc»mt cherge�fcu iht pc:ruiltrd <br /> wark incIuding macc�ials,lat,or,}�rofit,atu!att►et guced cosis, l�ig che amaunt to b�cl�asged[o►hc cuait�mer <br /> �OT'[J3C WOf�:d41pC. .Ik 8F}�A18iCF�8�, C4llFpQ1�IH, labor, w i�s�sl}acioQ uc furai:�tcd by the owncr,tenaac or <br /> any other pacry the rcaxonable mnrkec valu�i,f iuch items muse be acided to tihe aeeimateii e�sc os conerac� <br /> �ci�e.fcir permit fee p�es.,ln rlu evem thac Fbert is e disp�tr crn tbe aax�urx of the job eosr, the Ciry r�ay <br /> '.. . tequest �he 9uKmisaion uf a signed copy ��f'the aotual eortcract. <br /> '* "�'he STATE S1IRCHAKGF ir .UOOS of the convaci,prier untier S!,000,O(�or .�:SO• whichever is grea�er. <br /> f�o�yaluatians civer SI,�Q0.000 cali the Depaituunt ot Iaspeccioc�l Sesviccs}'cu the prica. <br /> T�]C UJl(iCFSF�t}CE��)Cfeb� �pp}iPS fD EF1C C�t� fOF t3SUafIC���fl MGC}1:1IITCe�I F�CCIiIpI, agr�es to d� a!? <br /> work in:strict ac�c�rdaE�ce wsth tl�e ��r�linancc:s Qf(he City ai�d the r��ulati��ns af'the Minnesota <br /> � :�tute f�iitd'eng C.`ode, and certifies that att statements made an chis appdicacion are comptete, true <br /> and correct. <br /> � A�plic�nt's Signafure: � � ;}ate: L� ���-��� <br /> Apgr+��ed By: - , � }?ate: � �:�����% <br /> � . �. . ,i . -- -- — <br />