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.�. . . . <br /> FIREPLACES <br /> Gas factory fireplace <br /> Wood burning factory fireplace with flue <br /> Wood Stove <br /> Wood stove with flue <br /> Brand Name Model No. <br /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. � Bath E�aust (must be ducted outside) �G cfm <br /> No.- —f�her Fans: Locations cfm <br /> � FUE��S�'ORAGE (MUST BE APPROVED BY FIRE MARSHAL) <br /> Insta�ia�on Removal <br />�?' Fuel'ail:� gallons underground inside outside <br />-<� LP Gas: � gallons <br /> Other Gas opening <br />� PERMIT FEE CALCULATION <br />�:, <br /> ' 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br /> ��"Oc�v "� x .0125 $ <br /> (contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division <br /> Surcharge to each permit. x .0005 $ <br /> or $.50, whichever is greater (contract price) <br /> 3. Posta�e and Handling (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ <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 installation are furnished by the owner, tenant or <br /> Fk=: <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 City may <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 is greater. <br /> For valuations over $1,000,000 call the Department of Inspectional Services for the price. <br /> � The undersigned 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 Minnesota <br />�� State Building Code, and certifies that all statements made on this application are complete, true <br />��: <br /> and correct. <br /> , �i � ��J , 2ti `__"�'� ����� <br /> Applicant s Signature: %��—�' Date: <br />� � <br /> Approved By: �� Date: 3- � �� <br />;;� <br />