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� �,S�p-07-99 06:63A Fireside Corner 612 633 8884 P.07 <br /> WO B � � <br /> � Wpod stove with flue '� <br /> VJood combin�atioa or add-on <br /> Factory fireplace wiih flue <br /> Factory Fireplace {s) Frees'tanding Masonry <br /> Wood Stove (s) Pranklin, other <br /> g�d�T�� Model No. <br /> Mfgr's Min., Clearances, side , rear , min. flue dia. <br /> Total <br /> �'Eh'TII,AT�ON <br /> No, Kitchcn Exhaust ducted rtcir�ulatiug cfm <br /> No. Bath Exhaust (must be ductcd outside) cfm <br /> N0. OLt1CT FSIIS: LOC2L1011S C� <br /> Total <br /> FUEL STORAGE (MUST BE A.PPROVED BY FIRE MARSHAL) <br /> Installation Removal <br /> Fuel oil: gallons underground insidc outside <br /> LP Gas; gallons <br /> Other Gas opening <br /> PE�T FEE CALCULATION <br /> 1. I.25� of Contract Price* or Minimum Fee (535.00) <br /> ���:5� x .0125 S .�'S'c� <br /> {coatracc price) <br /> 2. �tate Surcharge. ** Add the Srate Building Code Division <br /> Surcharge to each permit. ,[�,uu.�r� x .0005 S _ - Ss <br /> (concracc price) <br /> or $.50, whichever is grcater <br /> 3. P�stage and Handlin� {Only mail-in applications) $ _. -`-�'� <br /> 4. TOTAL PERNIIT FEE (Add Iines 1-3 above) $ 3S•�'� <br /> * CONTRACT PRICE or JOB COST means tbe actual or estimaced deUar a�ount c,harged for the permit[ed <br /> worl: including materisls, Iabor� pmf�t, and otber fixed cosu. Ii is the amount to be eharged co tht <br /> customer for tbe work done. If any maurial, equipmcat,la�r.or installatian are furnished by the av�mer. <br /> cenanc or azry ether patty thc rcasonable muka �aluc of suctt iurns must be added to the estimsted cost <br /> or contracc price for permic fee purposu. Ln the ovent thffi there is a dispute on tbe amaua�of the job cost, <br /> tbc Ciry may requast the submission of a signed c�py of the aetual conczact. <br /> *� The STATE SURCHARGE is .Q005 of the contraa price uadet 51,000,(f00 or S.50 - whichevar is <br /> greaur. For valuauons over SI,OOd,��ca11 the Depanment of Inspeerionat Services for the pricx. <br /> The undersigned hereby applies to the Ciry for issuance af a Mechanical Permit, agrees to do <br /> all work in scrict accardance with the ordinances of the City and the regulations of the Minnesou <br /> Scate Building Code, and certifies that all statemenu made on this apptication are complete, true <br /> and cortect. <br /> Appticant's Signature: ��-�t: ��t��� Date: _T�� <br /> Approved B�•: Date: <br />