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�� °�G �=l � `�'� <br />�� . . <br /> l�:'. <br />���_ <br /> FIREPLACES <br /> Gas factory fireplace <br /> Wood burning factory fireplace with flue <br /> Wood Stove <br /> Wood stove with flue <br /> Brand Name Model No. <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 /> �' v <br /> PER��iIT FEE CALCULATION lr�>����L � <br /> � <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) /�, � �' <br /> ���C��L��; x .0125 $ �� KI' �-, <br /> (contract price) <br /> 2. State Surchar�e. *�` Add the State Building C�ode Division �� <br /> Surcharge to each permit. �����'�, (, L- x .0005 $ � � <br /> or $.50, whichever is greater (contract price) � <br /> �� <br /> .\ . <br /> 3. Postaae and Handlin� (Only mail-in applications) $ 1.5 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ , ��G'. �\�`��� <br /> * CUN CRACT YKIC�or JUB CUST means the acival or es[imated doiiar amount ch�rged ior tne p mitted �'y <br /> �:.� work including materials, labor, profit, and other fixed costs. It is the amount to be cc�arged to the custamer , � � <br />�;r for the work done. If any material, equipment, labor, or installation are fiirnished by the owner, tenant or '�� l ` <br />�;�; <br /> any other party the reasonable market value of such items must be added to the estimated cost or contract <br /> price for permit fee 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 SURCHARGE is .0005 of the contract price under$1,000,000 or $.50 - whichever is greater. <br /> For valuations over $1,000,000 call the Department of Inspectional Services for the price. <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 /> Applicant'sSianature:G',,�����' /�-t. ' ������ � � � Date: `G-'�� � � <br /> Approved By: Date: <br />