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<br /> � '��� ' �� � .,��g , � �� , 6 k"�'f� yr = _
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<br /> �' *WOOD BIIRNING EQIIIPMSNT $15.00 each unit -
<br />�"� Wood stove with f lue
<br /> '`"_; Wood combination or add-on unit
<br /> ' Factory fire�lace with flue ��~�� ��,�°
<br />�,�� Factor Fireplace (s) freestanding . Masonry
<br /> � Wood Stove (s ) franklin, other
<br /> BrandName Model No.
<br /> Mfgr' s Min. , Clearances, side , rear , min. flue dia.
<br /> ` Total
<br /> � ********************************************************************************
<br /> �� VENTZLATION $15.00 each project
<br />� No. % Kitchen Exhaust ✓ ducted _ recirculating _=�c� cfm
<br />�m' No. -�, Bath Exhaust (must be ducted outside ) �fE, �:a- _� cfm
<br /> �,
<br />� No. Other Fans: Locations cfm /
<br />�..
<br /> Total �
<br /> ********************************************************************************
<br /> i FOSL STORAGE (must be approved by fire marshal)
<br /> � ' $30. 00 Permanent/Temporary
<br /> Fuel oil, gallons underground inside outside
<br />=��: LP Gas, gallons
<br /> e�Y Other Gas opening
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<br /> �,`� GAS LINE INSPECTION
<br /> ' High/Low Pressure $15. 00 �
<br /> ********************************************************************************
<br /> ,� P$RMIT FEE CALCOLATION ���
<br /> � 1. Total of above Installations or Minimum Fee ($30.00) $ (��� .,;;� �,;k,,����;
<br /> 2 . State Surcharge. Add the State Building Code Division
<br /> `` Surcharge to each permit $ . 50
<br /> 3 . Postage and Handling on all mailed-in applications, $ 1. 50
<br /> 4. TOTAL PERMIT FEE add lines 1-3 above $ j., L,�='t'
<br /> �� The undersigned hereby applies to the City of issuance of a Mechanical Permit, .
<br /> ' agrees to do all work in strict accordance with the ordinances of the City and �
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<br />�� statements made on this " pl ' cation � �` plete, true and correct. /
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<br /> ; Applicant' s Signature: .u.G�%" y Date: �� ��
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