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oct-Ze-Z003 04:84p� Fra-CtTT OF O�ONO �, T� �522414616 ?-868 �1.003/00� 4 .�'�
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<br /> . —�.�_� �� ❑Ya 1'bis Sectton Ap �j ��,
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<br /> T�1C 1�Cp]]RCCOSiq�t Of R$�IdE11h8I ft�nr Or annli�r��3t �a '" � �
<br /> , � fieets all tbree Of tbe f0 � : ' �=
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<br /> 1� ���re modi�cation to eleoaical�g�� ��
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<br /> 2� �A�oi SS00.00 c�lea�;�ccl�du cost of the fucutte ac appl�ance; � � ' �r,;
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<br /> 3) Ia improved,installed or ' . • - � �
<br /> replaced by thc homeowner ar licenscd co�nac� `� �` �_�'�'``
<br /> Slap aext sectia�; ; • � �����'��,.
<br /> Cost of Permit s '
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<br /> statc SurcharCe S-- -�r'— '`
<br /> Mail-Ia pa t_ i.so • '
<br /> If abov�e does not apPIY,tbllow guidelines be2ow; -
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<br /> l. S�4�traCt Ptt�e*is.0125°Yo of job with a ai , ,
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<br /> .. . . . � 1aoo, 00 � x.oizs� s 3s,op -
<br /> 2. t i "a ' *• (��� (�i�utms3s.00) ,�: �„
<br /> Add$e Stsie BW'�ditt ��,�� _.r_, �
<br /> . . �Code Divisiorr a�Fee of!S tm
<br /> . Ia00,dp x.o0o5 s � �o
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<br /> . (co�a�t prite) � a��,; �
<br /> 3.Ypstaae aad Hsndlln Oa (��+imwo s.SO) .
<br /> ( , �►ara�l,iit applleatlo�,$) � �
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<br /> a.TOTAL PE1tMI'1'gEE(Add liaes 1 3 ab�v�e) `.
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<br /> •corrr�u►crPwcsa�oB c�r�,� . �'"��� ��` �"
<br /> '�.�►,rrofl6 itnd odter sua coats tc is���d��ar nnomc ehargea for aK � . : ' .
<br /> ��M�C YIL'1 "', r, �
<br /> �4�w�abor,or iasteu.bon if r u r a i s h�a b y a K o w na �ro e6e a�soorpQ�r nb w o e l c a�..�}'m y► `�da' ' .�, . .
<br /> must be added w rha estimaced cott or eonnact •�c or�ny oeha qrry ehe r�k�y�ns otsueh� ' �. � .
<br /> �e job coat.�e City puy rc4t�tIu wbmissaan�o.f a si����.Ia du evep�qmt�ae is t dtspuoe a�tlu arnouer o�'
<br /> • �ned copy otd�e aetwl eoo�a�t, ; � p..
<br /> ••17�e STATE SURC�ARGE L.0005 uf the '� �
<br /> ' SI.00�.000 aU the ��P��SI.00p.000 or SSO.wbi�hevr�u �`y� � ` �,,~�
<br /> Depu�nm�c of Jnspeccional ge�,tc��p� S�a►Foe valu�io�u owr
<br /> � d�°wd�eanca�ef the C�iry u�d`i die regutadona�M °��Meth�nial Pamiti��do all w�ork in stria aoemda�q � � -
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<br /> �PN:�on aro eompteoe�true�nd eorrect. �S�e Buildin j Cade.and cersi8as d�tt sl���de oe�s b.',� '
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<br /> AppHcant's$ignattae: -
<br /> � Date: a�a�`p t�
<br /> Approved By: �
<br /> Date:
<br /> 3 _ _
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