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. �r�voo� Bu�v�vc Eau.���N� � <br /> - , . <br /> Waod stave with flue <br /> Woad cQmbinatian or add-o�� <br /> Factory �replace with flue <br /> � ra�tory Fueplace (s) Fre�standing Masonry <br /> Wood Stove {s} , Frat�lz�, othcr <br /> $rand Name Mod�1 No, <br /> Mfgr's Min,, Clea�'ances, sid�;______, rear , rnin. flue dia. ��_ <br /> Tc�tal <br /> jlE1VTILATION <br /> No. ' �itc�.en Exhaust ductecl rccirculating cfm <br /> Np, � B�tlf� �x1�lust (must be ducted outside� cfm <br /> No. 4t�er Fans: Locatio�s cfm <br /> Total ;� <br /> ��UEL ,�T�7RA.GF.. (MIJ,�T B� APPRQVED �X FIRE MARSHAL} <br /> ^ Tnstallation; � Removal f <br /> Fuea c�il: � gatlons )( underground inside �utside <br /> LF �as; n gaitc�ns . <br /> �,� �lt��r _�����L�d _._...._� --- Gas openin�; <br /> F'ERMIT FEE CALCULAT�4]V <br /> 1 1.25% o� Contract Price'� oz Minimum Fee (�35•DU� <br /> lS—UO�DD x .0�2� � :�-.� ,C�C� — <br /> (Cqt�tract Price) <br /> 2. State Surchar�e.. ** Add the State Buil.din� Code Division <br /> Surchar�e ta each pe�mit. /��' ��0 � .4045 � ��S <br /> (CUntY20t �rir,e) <br /> or $,50, whichever is greater <br /> 3. Pos and Handlin (Oniy mail-it� a�plicat�vns) $ 1.50 <br /> 4. '�QTAL PERMIT FE� (Add lines 1�3 ab�ve) $ �� �" <br /> .--- <br /> "` CQNTRACT PRIGE or JOA COS'�'mcans thc actual �r esti�xlatcd dollar amount charged for thc pez'micted <br /> work including materials, labor, profic, v�►d other i'ix�el to�ts. It is the amo�nt io be c}iargcd to the <br /> eustomer for the work done, ��'any macerial, equipment, labor, or i��s«ll�Ztion are furnishcd by Cl�c owner, <br /> tenant or any other party the reasonable market value of such items must be added t4 [hc cstiu►ated cos� <br /> ar coutraet price for penuit fee puiposes. In ttie event that there is a dispute on the amounc of rhe job cost, <br /> [he Clty may zequesc chc submission of a signrd copy of rhe aetu�l contract, <br /> "'" The STATE SURCHARGE is .Q005 of the contract price under �1,000,000 ur $.50 - wl�ichever is <br /> greater. For valua�ians over $1,OQ0,040 call the Dcpxrtmcut oC Ityspectional Scrvices for thc priee. <br /> T�ie undersigned hereby applies to the Ciry for issuance of x Mechaiucal permi[, agrecs [a cia <br /> alll woz'k in striet aecordance with the ordinances o�tt�e City and the ze�ula�iulls o�thc MuiAesota <br /> State Building Cod�, az�d ceztz�es that all statem�nts made on this applic:.�tiozi are complete, true <br /> R1.1C�. COI"1'�Ct. . <br /> �PPlicant'sSignan�re: .. �'� Date:� � � — <br /> , <br /> A.pproved By: Date: <br /> --------�------------------------------------------------------------------------------------------- --- <br />