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<br /> . WO@�,D:�B��l'rT��EOUIPMENT
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<br /> � ��, �'�VVooii sto�e with��'�lue �
<br /> �Wood combination�ar add on,;
<br /> Factory fireplace�witti,flue
<br /> �.,. '
<br /> � � � ���Factory Fireplace'�(s) �� �� � ��Freestand�g �� `Masoiuy � � � �� � � �
<br /> Wood Stove (s) �Franklin, othe�
<br /> Brand Name` Model No.
<br /> Mfgr's,;:Min.,=.Clearances, side ,,;;. reat M ; . min:.tlue dia:
<br /> VENTILAT�ON� + , . ., ' ; , -,
<br /> "1�10. Kitchen E�chaust-� duc"ted -z.� `r.ecuculating ' cfm
<br /> No. ` Bath Exhaust �(must be ducted `outs d '. ` cfm
<br /> No: Other-Fans�� k:ocatxo�.s�. x;: , cfm
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<br /> FUEL:STORAGE. .�MUST BE APP.IZO�D�$X FIR�,.MARSHAL).
<br /> ��:
<br /> InstalIatioi� Removal ��;,,��
<br /> Fuel oil� gallo�s ' ���;��ii�der�'rQwp►d inside outside
<br /> LP Gas: gallons ��}'�;I�'�
<br /> Qther .Gas o,pening.
<br /> PERMIT Ft'E ;F CALC���. ° " ON .
<br /> � 1. v�1:25% of Contra '°��or��mum Fee ($35:;00) r (��")
<br /> . . ���� r.1: � �;k 1,��.c�_/�.,.O�ii� �� � ��� V ��V . . � .
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<br /> __ _ ' C'O]1CI�d��"� E' _
<br /> � r � _�. ._..__: �.. _ _..._ ... _
<br /> � :.� $"urchargeho�each ����d tlie State Bu��'Co�e biXision , � � ' � �
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<br /> . p 1 OOUS` $ �J . �
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<br /> ' ox $.50' hever is gre�ter ' (concracc�price). . '
<br /> . ; wluc
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<br /> 3. Posta�e,,'and�.Handlin� (Only mail.in applicat�oaCis) $ 1.50
<br /> 4. TOT1�I;r P�RIVIIT FEE� (Add lmes�1 3,frabavej $r `� ,�.�., � -��
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<br /> * GONTRACT PRICE or JOB COST�means the,actual or estimated,dollar ai�iount.chatged for the permitted
<br /> work including"materials, labor, .profit; and other fixed costs. It is the amount to be chazged to'the
<br /> ;customer.foc the work-done If�an}�matenal, equipm�nt,j bwr,�or�nsi�alladon are furnished by the.;pwner,
<br /> � � �
<br /> �t�nant or aany1�b�lier par�y the ieasonable inarket value o�Sn�i ate�i�mt�st be �dti�,d'to the,estimatec� cost
<br /> - . , ..:. . . : r ,a �; � ,� � � �,
<br /> oi�contract.�price.fos perBut f�e purpos�s 7In t��eve�t thatsthet'�is a dispute,on the amount ot�the job cost,
<br /> the City may request the submissi�On of a s�gned cogy of th'e ac�ual,;contract. '
<br /> , ' ** The STATE SURCHARGE�is 0005��of th�e:cogtract�pfice,;und�r ;$1'Y000;000 or $.50_- whichever is
<br /> greafer. -For":valuations over $;1,OOU;U00 ca�1=„the D�gaz'time�it tio�Inspectional�Serviees for the price.. :
<br /> The undersigned hereby applies to t1i��City',�fo� issuance��af a N�e�hanical P�rmit; agrees to do
<br /> ` all work`in strict accordance ith the ord�naiic.�s of�tHe Ci ` and,�the,regulations of the Minnesota
<br /> State Building Code, and ce "ies ttiat all sta�m nts:,zn ,e; =�n tFus applicat�on�,are complefe; true
<br /> � � and correct. , � ' ; � �� � �
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<br /> Applicant'.s Signature: � �' Date:
<br /> APProved By: , �. . nate:
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