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7-25-1997 4:35P�•1 FROM F I RES I DE COR�R 612 633 8884 P_ 3 <br /> � t � <br /> • .,,,, <br /> O D B ' E CTIPMENT <br /> 'GYood sto�e with flue <br /> Wood combinacioa or add-on <br /> Factory fireplace with flue - <br /> �accory Fireplace (s) Freestandina Masonzy <br /> Wood Stove (s) � Fzanl:lin, other <br /> Brand Name Model No. <br /> Mfar's Min., Clearances, side , rear , min. fluc dia. <br /> ATI <br /> No. Kitchen Exhaust ducted recir�ulating cfm <br /> No. � Bath Exhaust (must be ducted outside) _ ' cfrn <br /> No. Ocher Fans: Locatioru cfm <br /> L ST E (MUST BE APPROVEl7 BY FIRE MARSHAL) <br /> Installation Removal <br /> Fuel oil: gallons underground inside oucside <br /> T P Gas: gallons . � <br /> Other Gas opening <br /> TI` ALC AT�ON <br /> 1.25% of Contract Price* or Minim Fee � 3�O1 <br /> 1 1�� x .OI25 $ <br /> (coatract price) . <br /> State Surchar�e. ** Add the State Building GQde Divisian <br /> $urCh3tge t0 P,2Ch pEiiIIit. / ���� X .�S $ <br /> or 5.50, whichever is greater (concract price) <br /> Posiaae and HanfllinQ (Only mail-in applicauons) � .SO <br /> TOTAL PERMl"T FEE (Add fines 1-3 above) � 3') � � <br /> ' COr'TRACT PRICE or 10B COST mcans the acival or esamated dollar a�,nouac.charged for the permicccd <br /> work intiuding materials, labor, profit, and ocher fized costs. It is the amounc to be chaTged to che <br /> cuscomer for the work dona If aay maurial, cquipmenc, Jabor,or instailauioa are furnished by cbe owner, <br /> iena�� or any ochez parcy �reasonable inarkec vaiue of sueh iums musc be added co the esuznaced cosc <br /> or coacracc price for permit fte putposes. In tht eveat�bac rhere is a dispau on[bt amoaat of c�e job cosL. <br /> che Ciry may roquesc che submission of a signed copy of the aetual coatra4ct. <br /> "; �he STATE SURCHARGE is .0005 of the contract price under SI,000,000 or S.SO - whiche�er is <br /> greater. For�aluadons over$1,000.000 call che Departmene of Inspectiona! Servicts for the pnce. <br /> e nudeni�ned hereby a�plies to the Ciry for issuance of a Mechanieal Permit, agrees to do <br /> ll work in strict accordamce with che ord'znances of che Ciry and the z�egularions of the Mi�nnesota <br /> tace Buildin� Code, and cenifies that all statemenrs made on ihis applicarioa are complete, true <br /> d correcr. <br /> PPlicant'sS�anatu : Q. Date: � -�Cy'�. <br /> pproved By: Date: <br />