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12-01-1997 d:01PM FROM FIRESIDE CORNER 612 633 8884 P_ S <br /> , <br /> Wood sLove cvith flue <br /> Wood combination or add-on <br /> Factory fueptace with flue <br /> _� Facwry Fireplace (s) Freestandiug Masonry <br /> Wood Scove (s) Franl:lin, ocher <br /> Braad Name�(�e���(l(,�te Model No. .,,� T,�'� <br /> .. <br /> Mfgr's Min., Clearances, side , reax , min. flue d'za, <br /> r�,�,xro <br /> No. Kitchen F.�chaust ducted rec'u�ulating cfm <br /> No. Bath Exhausi (�musc be du�ted ouuide) _ � cfm <br /> No. Other Fans: LAcations cfm <br /> STO (MUST BE APPROVED BY FIRE I�ARSHAL} <br /> Inscallation Remo�ai <br /> Fuel a'il: gallons underground 'z�side outside <br /> LP Gas: gallons ' <br /> Othez � Gas o�eaing <br /> E FE� C C I N <br /> 1.2�� of Contract Price* or Minimum Fee ($33.00� <br /> ��� /�p x .0125 $ ,��.o� <br /> (contract pr�cc) <br /> Stace Surchar�e. ** Add the Stazc Buildin; Code Division <br /> Su.rcharge to each permit. x .Q005 $ . 55' <br /> or �.54, Whichever is greater (cooczact price) <br /> �. FostaQe and �iandlir�, (Only wail-in applicacions) S 2.50 <br /> TOTAL PERMIT FEE (Add lincs 1-3 above) S �?.o� <br /> * CON7RAG7 PRICE or JOB COST means tIIe accua�or esriraacod dollaz amoem�charged for che permiited <br /> work induding macerials, labor, profii, and other fized cos�,s. It is the amouac to ba chazged to ci:e <br /> customer for tbe work done. If aay matcrial, tqnigmenc, labor, or insraIlaiion ase ftuaished by the oaner, <br /> ceuanc or aay oth�r pazry zhe rtasonable mazlcet vatue of such ice�s must be added co thc escimaied cosc <br /> or oontract price for permi�fet purposes_ Ia the evenc tbat tbere is a dispuce on the amou�t of che job cosc, . <br /> iht Ciry may requcst rbt submission of a signed copy of the accuai eoatrdcc. <br /> '� 'Ihe STATE SURCHARGE is .0045 of �he con[ract pric,� under S1,000,000 or 5.50 - whie3�wer is <br /> gzeater. For valuacions over 51,000,000 call the Deparcmeni of Insgeciivnal Scrvices for ihe price. <br /> e +�udersigned hereby a�plies to the Ciry for issuance of a Mechanical Pernut, agrees to do <br /> ll w rk in smct accordance with the ordvoances of che City and the regulations of zhe Minnesaia <br /> Late Buildin� Code, and cenifes thac all sraEemenu made on this appiication are complete, trtze <br /> d onect. <br /> pp caat's Si�ature: �Q�f�, �,� Date: /' / 9 <br /> pp ved By: Date: <br />