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+�II � <br /> _ r , <br /> FIREPLACES <br /> Gas factory fireplace <br /> Wood burning factory fireplace with flue <br /> Wood Stove <br /> Wood stove with flue <br /> i�ranci Iv ame i�iouei irTo. <br /> Cl; 2�`� � i�� � � . �� � �'� �'S, 1 C�k-`�, 1 �c`Z�he-- � �, I 1,��.c� I�ea�-{_ <br /> � � <br /> VEi�'TIL�iTION <br /> No. � Kitchen Exhaust ducted recirculating %��fm <br /> No. _� Bath Exhaust (must be ducted outside) cfm <br /> No. � Other Fans: Locations �'�� �-v�S � l.�u���_�� cf <br /> �',�-�'r�`'� �-e-�c�� `� ���r►'� "� V E v�rY��r 1• -��f' ���'`'� <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) <br /> Installation Removal <br /> Fuel oil: gallons underground inside outside <br /> LP Gas: aallons <br /> Other Gas opening <br /> PER:VIIT FEE CALCULATION <br /> 1. 1.25� of Contract Price* or Minimum Fee ($3�.00) <br /> '� L � .0125 $ ���, �J <br /> contract price) <br /> 2. State Surchar�e. ** Add the State Building Code Division <br /> Surcharge to each permit. a'� �j(�O � c� x .0005 $ � � , (�� <br /> or $.50, whichever is greater (concracc price) <br /> 3. Postaae and Handlina (Only mail-in applications) $ -�— <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ "�� ��; 1S � <br /> * 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 charged to the customer <br /> for the work done. If any material, equipment, labor, or uistallation are furni�hed 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 Ciry may <br /> request the submission of a si�ned copy of the actual contract. <br /> ** The STATE SURCHARGE is .000� of the contract price under$1,000,000 or $.50 - whichever is grea[er. <br /> For valuations over $1,000,000 call the Department of Inspectional Services for the price. <br /> The undersi�ned hereby agplies to the City for issuance of a Mechanical Permit, aarees 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 Signa re:� � � Date: � —��3 `��� <br /> Approved By: Date: <br />