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CITY OF ORONO � 61�4tSU��U Uy/U1/��t 14:�t � :U�/U� Np:4(�� <br /> . i <br /> �������� <br /> 1. I.2S 9� of�;�ct.Price* or I�nlmum Fee ( 3".UO) <br /> � x .0125 $ =';L-, r i�_� <br /> (cantract price) � <br /> 2, �tate Surc r� "'* �+1dd the State Buildin,� Cc�de Divisicm <br /> Surchar�� ta each perm it. � � x ,Qq05 $ • ``�U <br /> (contrac;t priac} "T"'�"""'— <br /> or $.50, whichever is great�r -----�.� <br /> �. ���� an�1 Hand..i� (f3nly '1-in a li• ians -' $ �:�--= <br /> 4, T�TAL PE�'tMIT ��FE (Adci Iines i-3 above) $ , ��._ �3c�, r�. <br /> * CC?NTRACT PRICE nr JOA C4ST metuts the�ctqal or eatimutcd dollar amount chargcd for the permitted <br /> rvark Inciuding materials, lAbar, prafit, f�lld OthBt fIXG(� C09I3, It is tlie umoupt [o be chrugcd to tl�c <br /> cuetorn�r 1'ar tt�e work done. If any matr.ri�l, cyuipment, l�bor, or inatallalion are furnish�d by the owner, <br /> tonant or any ochcr p�rty ttwe reasonable markct vakue oi'auch icecns must bc added to ehe estimated cast <br /> or c.�mr�cl price for permit fce purpaees, ln thc event t3iat therc is x dis�ute ou die amount af the jab cost, <br /> thc Ciry may reyuest the submiesio�� of a s�gned cnpy of the actual contrxc[. <br /> '"* The 57'A7'� SURC''F�ARGF ia .0005 of the contruct prica under $I,OUO,U00 pr $.SO - whichever i� <br /> grcatar. For vAtuulians ovCr $1,OOQ,000 cpEt thc Aepartment of Inspectianal �5ervices Far tl�e pricc. <br /> The uricfersigned lle�reby �pP1i�s to the City for is�suancc af a Plumbing Permit, agrees tu do ali <br /> work in S�rict acct�rdanc� with the ariiinances of the City and the re�ulations of th� State af <br /> Mi�ne�ata, anc! certi�es th�t �11 st�t�ments made on this applicatiim are complet�, true and <br /> COl'tCG�. <br /> ,/'� <br /> � <br /> AppJi��nt's Signaturc: ��� � - " _Date:o��✓ �� <br /> 'I <br />