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<br /> Gas facwry firepla,ee � . " � '
<br /> Wood b"� factAxy fireplace with flue
<br /> Wood Stove � .
<br /> Wood stove with flue � �
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<br /> VENTII.ATION .
<br /> Na. Kitchen Exbaust � ducted recirculating �cfm �
<br /> . No. ' Bat��Exhaust '(must be dwct�d.outside)'. � ' cfm � � . ,
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<br /> No. Other Fans: Locations� . . . � � cfm .
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<br /> � • • • ' � �° 'CONTR�►CT PRICE ar.30B.COST m�ns dr�:�xnal'��dollu af�umt cbarged;fnr'die pecmtued • • ,
<br /> ' � ' ' + �•aor]�i�elniling a�ial�s;l�nb�,PmBt,`�:�'r•�iyed�cosrs.It is�e amn�i�o be chazged'stia`�ffiie''�aioo�r.;. .
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<br /> . • ptkss-for permit fee purpoees. Txt the'Cverit t]iat�e is a dispate on�die amount a�'tl�e 3ob cost;th's taty may .
<br /> requesc rlue snbmissio�of a sig,wed c�y of rh�acnial comaacc. , ' ' � , •, • , .
<br /> ** The STATE SURCHARGE is.0005 of the eontraa price vader 51,400,000 or $.50=whi�chever Is�c-
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<br /> • ; - ';'''The ufldeTsig]O�ed heteby app]ieS t0 d�e t�ty,•:forvis5ua�ce•of.a M.Pr.hA,,;c��µ�;,:. ,.agne�g�,x,0.dp.all,,.;.;.,,�,;.
<br /> � work in sdrict'accordancx with the ordi�oances of�e�City and the regula6ons��of'tlie�lV�ia�ne'sota '
<br /> State Building Code, and certifies that all statem�nts made ori this applXcarion arc complete, txue
<br /> and correct.
<br /> APPlacan�'s Signacure: Date: � � ¢' �
<br /> Approved By: Date:
<br /> L00 f�jj �i'IddR5 5iI�Q'IIf1S SiI�lifi9 LS80C5SC9L YV3 bi��OT t0/LZ/ZT
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