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4 <br /> FIREPLACES <br /> � Gas factory tireplace <br /> Wood burnina factory fireplace with flue <br /> Wood Stove y <br /> Wood stove with flue <br /> Brand Name '���,��' tilodel No. > > �� <br /> VENTILATION <br /> No. Kitchen E�aust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> No. Other Fans: Locations cfm <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 /> PER�IIT FEE CALCLTI.ATION <br /> 1. 1.25% c�f Contract Price* or Minimum Fee ($35.00) <br /> ��Co�.C,� x .olzs � � 35,0� <br /> (contract pricej <br /> 2. State Surchar�e. "* Add the State Buildin� Code Division <br /> Surcharge to each permit. ��C�� .C U x .0005 $ �, �_ <br /> or $.50, whichever is greater (contract pricej <br /> 3. PostaQe and Handlina (Only mail-in applications) $ 1.�0 <br /> 4. TOTAL PERI�IIT FEE (Add lines 1-3 above) $ �^� kX <br /> -.-o-�— <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the r�rnutted <br /> woric inciuding materiais, Iabor, proiit, and o�her iixed costs. It is the amount to be char;ed to the customer <br /> for the work done. If any material, equipment, labor, or installation are furnished by the owner. .enant 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 even[that there is a dispute on the amount of the job cost, [he Ciry ma} <br /> request the submission of a signed copy of the actual contract. <br /> ** The STATE SURCHARGE is .0005 of the contract price under�1,000,000 or �.50 - whichever s greater. <br /> For valuations over �1,000,000 call the Department of Inspectional Services for the price. <br /> The undersiQned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all <br /> work in strict accordance with the ordinances of the City and the regulations of the �iinnesota <br /> State Building Code, and certifies that all statements made on this application are complete, true <br /> and correct. <br /> .�.,r,ic:r.c�s �;�,;.ra:e:j'� 2�� ��G�Z�e�-�-�-�--_� n��P� %�/Ga <br /> rr � <br /> Approved By: Date: <br />