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CITY OF ORONO � b122494616 06/01/99 09:30 � :03/03 NO:b85 <br /> � <br /> i <br /> � `�V'Ot)D�8�5C�FS��I��`j` <br /> 1Waod atavc w�th flue <br /> �V'ood �ombiAation or �d-o�a <br /> ____„� FacEory fu'eplaco with flue <br /> � Factary F'�replace (s)�____ Freesia�ding Masonry <br /> _____^ �4'aod�tnv� (s) Frat�cl�ri, ot�xr <br /> B'rand Namc Model Nn. <br /> Mfgr's Mi�., Glearances, side , rcar , mtn. tluc dia. <br /> YENTII.ATIQN <br /> No. Kit�lie� Fxl�wst �dttcted recirculatirag cfm <br /> No. � Bath '�xhau�st (must be d�tct,r,cl outside} �cfm <br /> Na. Othar Par�s: Lacstians cf� <br /> . ...,...._, <br /> ,(MUST BE APPRUVEp BY FIRE MARSHAL) <br /> � �t� ahat� � Removal <br /> .��... Fuot oil: �,;� gallons � undar�w� Inaide outside <br /> LP Gaa: ga�oas <br /> Other t3es apcning <br /> EEi�MiT 1�T�.�1��I�N <br /> 1. 1.259b �f Coatract P��ce� or � Fg (53�.�) <br /> v� x A22S $ ^�tOA'� _----......, <br /> t��) <br /> : �. 5tace 8uncharac. *+' Add the State 8uildi�tg Code Divisinn 4g <br /> surcharge to cacb per�ic. � Co 9�o.'° x .000s $ 3• <br /> o� �.S0,whici�evar is greater (cooieaa prke} <br /> 3: (On1y mail-in applicaiio�s) S - 1,54 <br /> �4. TOTAL PERMIT FEE (Add lines 1-3 above) S ,_,,, 1 +�� , <br /> � CONTRACJ'PRICB�JOS C4ST nxaoa thc�ctual�atinwe,d do!!sr amouat cbar�td ior the parmittcd <br /> wack i�cluding enxter'sat:. labor, pcotEt, and othar iixed �costs. It is the smount to be charaed to ahe <br /> C$310d1'1DiE'fAf 1}JC WNDI�C�l1C. �YtSy I114{GFfOi�O�EI�s IRbOt��iJ16�A���ICN!14rw �nu.�m:M.e'°�^ ��` ...� ......�.. <br /> ta.r.��n�rs a��tw�r_wert�l t�� wac �3 <br /> .......,, . ;_., .,.�aabk maricei valwe nf nich itea�s must be added to ti�e e�ttauted c� . <br /> or c�t pricx fvrp�crmit fa p�ttp�a. 1n tbe ev�e�thu the�is a di�ute on t�e Amous�c o!rhe}ob cc�st, <br /> the Ci�r msy sequaat the a��c+n oi a sigaed cx�r of tlae actu�l coatfact. <br /> •�' The STATE SURCHARGE is .4005 oi ttt�c�tc�ect ptice a�dec St,U00,0Ud or �.SO - w�khever is <br /> 4tl�aECf. �Of Y�}U�t�D1!!OYC!'��.�_Q�CR� L�lD��ffiCif1 i���I3S0[�II[)It� �tSY�C£.4 fnr rtiw nr?��. <br /> `i'ww � wHs�.wwbtis`»M �..«,-+... ..i..+» •�.w i tis�r iw.. :ww••nw.+w r.i� w ww�waww:..ni i�w�...•:s- .ew <br /> siH:. uiwe�aa�i�u uvicu�r o�uw iv u� �,.uy i�a ►aaua�n.�: vr� � iF.`�.���..�,::e. :___:__-- �____:: �.s �� <br /> a!t wock it� str�ct accordanct with the ord'utatxxs of the City at�3 thc regui�iions oi cne Minnesota <br /> Statt Bui�c�ing Coda, and certifies tt�at a11 statcr�ents made on ths� ���a --- -- __- - - --- =- __ <br /> s�l cottcs:t. <br /> Appticant's Sigmtture: � ..G-- ����d 3 0�. Date: _ '�'�� <br /> Approved 8y• Date: ��/D "�� <br />