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r'} <br /> 'fe <br /> �i <br /> . � ` � <br /> � <br /> � <br /> ,� <br /> FIREPLACES ��po�° � <br /> _�_ Gas factory fireplace �� '� <br /> Wood burning factory fireplace with flue � <br /> Wood Stove � <br /> ; <br /> Wood stove with flue � <br /> Brand Name Model No. `�h <br /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. �� Bath Exhaust (must be ducted outside) cfm �' �:���-�'' ` <br /> No. Other Fans: Locations cfm <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) <br /> Installation Removal <br /> Fuel oil: gallons underground inside outside <br /> LP Gas: gallons <br /> Other Gas opening <br /> - ;� <br /> PERII�IIT FEE CALCULATION '� <br /> 1. 1.25%o of Contract Price'� ar Minimum Fee ($35.00) ��� <br /> <� ��%c � ��� X .oizs $ �3�, � � � <br /> (contract price) � <br /> � <br /> 2. State SurcharQe. ** Add the State Building Code Division <br /> Surcharge to each permit. x .0005 $ <br /> or $.50, whichever is greater (contract price) <br /> 3. Postage and Handling (Only mail-in applications) $ 1.50 ; <br /> 4. TOTAL PER�VIIT FEE (Add lines 1-3 above) $ <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted <br /> work includinQ materials, labor, profit, and other fixed costs. It is the amount to be charged to the customer <br /> for the work done. If any material, equipment, labor, or installation are furnished by the owner, tenant or <br /> any other party the reasonable market value of such items must be added to the estimated cost or contract <br /> price for permit iee purposes. In the event that there is a dispute on the amount of the job cost, the City may <br /> request the submission of a signed copy of the actual contract. . <br /> ** The STATE SLRCHARGE is .0005 of the contract price under$1,000,000 or $.50 - whichever is greater. "' <br /> For valuations o��er $1,000,000 call the Department of Inspectional Services for the price. # <br /> .� <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all ;� <br /> work in strict accordance with the ordinances of the City and the regulations of the Minnesota � <br /> State Building Code, and certifies that all statements made on this application are complete, true '� <br /> and correct. <br /> < � ' , <br /> Applicant's Signature: � f 1,C��"L � • ,��L�� Date: C�S CT <br /> Approved By: Date: <br />