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' � ' <br /> . , - , <br /> ���� ���t� ���.�'il�rl'I' <br /> Wood stove with flue <br /> Wood combination or add-on <br /> Factory fu-eplace with flue <br /> Factory �ireplace (s) �reestanding Masonry <br /> �'ood Stove (s) i ranklin, other <br /> Brand Name Model No. <br /> IVlfar's Min., Clearances, side , rear , min. flue dia. <br /> Total <br /> �l�t'�'II.��'�O�t <br /> IVo. Kitchen E:haust ducted recircuiating cfm <br /> No. �ath Exhaust (must be ducted outside) cfrn <br /> No. t7the: rans: Locaiior�s cfm <br /> '�'otai <br /> �'U�I�.., ST�RAGE (NIUST BE APPROVED BY FLRE MARSHAL) <br /> In.stallation Remaval <br /> Fuel oiL• gallons underground inside outside <br /> LP Gas: � gallons <br /> Other Gas opening <br /> PE���` �� CAI_,�IJ�.A'I'��P�I <br /> 2. 1.25% of Contract Price�` or Il�:�i�a�� Fe� �$35a0Q) <br /> `-j �SS. bC� x .0125 $ �O • �� <br /> (contract price) <br /> 2. �tate Surchar�e. ** Add the State Bu�ldin� Code Division <br /> Surchar�e to each pernuf. `�i� SS. o v x .0005 $ �` 2 - �-I � <br /> (contract price) <br /> or $.50, wrschever is greater <br /> 3. - Postage and �Iandlin7 {Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ !o�-j. .� Zr <br /> * CONTR.ACT PRICE ar JOB COST means the actuai or estimated dol2ar amount charged for the perm;tted <br /> work including materials, labor, profit, and otlier fixed costs. It is the amount to be charged to the <br /> customer for the worit done. If any material, equioment, labor, or instailation are furnished by the owner, <br /> tenant or any other party the reasonabie market value oi such items must be added to the estimated cast <br /> or contract price for permit fee purposes. In the�vent that there is a dispute on the amount of the job cost, <br /> the Ciry may request the submission of a signed copy of the actual contract. <br /> ** The SiATE SURCHA.RGE is .0005 of the contract price under �I,Oa0,000 or $.50 - whichever is <br /> ffreater. For vaivations aver $1,000,000 call the Department af Inspectional Services ior the price. <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do <br /> all wark i.n strict accordance with the ordinances of the �ity and the regulations of the Minnesota <br /> State Buiiding Code, and certi�es that all staternents made on th.is application a�e complete, tx�e <br /> au� correct. <br /> � <br /> �.ppiicant's�ignature. � _ � C.i�� I3ate: � 1 C: c��., <br /> > <br /> r�pnroved�y: Dace: <br />