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. <br /> �VOOD BtiR.ti�TG EQUIP�IEN'I' <br /> `Voad stove with flue <br /> Wood combination or add-on <br /> � Factory fireplace with flue Maso <br /> Factory Fireplace (s) Freestandin� �Y <br /> `Vood Stove (s) Franklin, other <br /> Brand Name r�u i��C Model No. � l� <br /> �1fQr's yiin., Clearances, side `�_, r���� <br /> min. flue dia. � <br /> VENTIL�TION <br /> No. Kitchen Exhaust ducted recirculatingc� cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> No. Other Fans: Locations <br /> FUEL STORaGE (MUST BE APPROVED BY FIRE MARSHAL) <br /> Installation Removal <br /> Fuel oil: gallons under�round inside outside <br /> LP Gas: gallons <br /> Other Gas opening <br /> PERiI�IIT FEE CALCTJLATION <br /> 1, 1.25 90 of Contract Price* or Minimum � ($3$-00)x .0125 � <br /> /{-�XS — <br /> (contracc price) <br /> 2. State Surcharae. ** Add the State Buildin; Code Division <br /> Surchar;e to each permit. x .0005 � <br /> or �.50, whichever is greater (contract price) <br /> 3, Postaae and Handlin� (Only mail-in applications) � <br /> 1.50 <br /> 4 TpTAL pERMIT FEE (Add lines 1-3 above) � <br /> * CO`1TRACT PRICE or JOB COST means the acrual or estimated dollar amount charged for the permitted <br /> work including materials, labor, profit, and other fixed costs. It is the amount to be charged to the <br /> customer for the work done. If any material, equipment, labor, or installation are furnished by the owner, <br /> tenanc or any other party the reasonable market value of such items must be added to the estimated cost <br /> or con�ract price for permi[fee purposes. In the even[that there is a dispuce on the amount of the job cost, <br /> the City may request the submission of a siened copy of the acmai con[ract. <br /> ** The ST'�TE SURCHARGE is .000� oi the contract price under 51,000,000 or �.50 - whichever is <br /> Qreater. For valuations over S1,000,000 call the Department of Inspectional Services for the price. <br /> The undersi�ned hereby applies to the City for issuance of a Mechanications of theQMeinne�ota <br /> all work in strict accordance with the ordinances of the Ciry and the regul <br /> State Buildi.n� Code, and certifies that all statements made on this application are complete, true <br /> and correct_ <br /> � �/ �J Date: , '�� � <br /> �,pplicant's Signature- ��'� �i l °�y — . <br /> Date: <br /> A.pproved By: <br />