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<br /> �v�a�-; ' :�:-rtr�n�G �ourp�rF��� t�
<br /> Wood stove tivith fl��e
<br /> `� j ' Waod combination or a�d-on
<br /> ` __ Fact��s•y fireplace �,vith �ue - ,
<br /> - - -__
<br /> . � ' Factory Fireplaee (s) _____..__ �`re�sr�n��i�tg Masb�lry
<br /> _ _._ Wood Stove (s) ____ Frankl in, other - -
<br /> : ; - �_-__ ___�_ - _
<br /> � ' � s ��:�c� Narrie �1�c�de1 No. '_ _, __
<br /> - ° ':'t�r's 1VIin., Clearances,�sid� _ ____, rea�r __-_____,^ min. flae dia. �
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<br /> � ti.� � ���r�� f - .'
<br /> ` '� r <; j�� Kitchen F.xhati�t d�jc,te�i recircutating ei " �-
<br /> � �i Bath Exhaiist (n�list be claac.ted out�icie) cfm `
<br /> � ;�____ _—� .
<br /> Othe� Fans: L,oc�ti�fis _-- ---------------- c``:
<br /> �;�`�' . g'��.RAGE (MUST BE APPROV�:T> BY F�l2E MA}tS�IAL) �'
<br /> �',Fallation Removal � ;
<br /> � Fuel oil: _ gatloiZs __.__ uncl�:i�gcound inside .��e
<br /> .
<br /> '� '_ .__ LP Gas: ------- galtons ��--- `�
<br /> , --
<br /> ' ' Other Gas op _
<br /> _ . e�
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<br /> , :, ____,__�_. ..._ _ .-------- ----- ----- --- -
<br /> --- --- ;
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<br /> ���: i' �'EE CALCULATI N
<br /> . ` � ' .?5% of Contract Pzice�` or �rit�i�t�u�s� �.cc C�35_.0�� � •
<br /> _ '_ �� __ /l ����_ �_-� x .0125 $ �l� — _
<br /> , (conicac,t p�ice} �
<br /> 2. : 1 :;��e�urchar�e. *�` Add t1Ye State Builc�in� Code Division - a.�_
<br /> , . x .0005 $ ` '` ' .
<br /> � _ <ttcharge to each pe�m�it. ` ' " -
<br /> ____ ._---- ----- ----
<br /> � ��° $.50, whichever is great�r (cotlsract p�+cc)
<br /> 1-
<br /> � '^_
<br /> �, ` `�` `�,;.t��e and Handline {OnIy r���il-in ap�lir.atio�s) $ .; --
<br /> C.r 4
<br /> - 4. ' " � ;;i�TAI.. PERMIT �F,E (Add Iines 1-3 above) $ �,,,_'t =. .. � t .._
<br /> : R .t;
<br /> ' s?N"fRACT PRICE or JOB COS"T n�e�t�s tr,e acr�.ral or estit7-�ated d��llar amount charged #'c,< < ,-.?d
<br /> ` � ����rk including materials, lati��r, p�c�fit, and a,l-�er fixed cu;ts. It is the amount to b? � � ` �� t3�e
<br /> E_>:�;�n�er for the work done. �f any n�.;tertat, ecn�i�s�cnt, laEx�r, or �nstallati�n ate furnislzec! �� '=��. _
<br /> . �:.�nt or any other party'th� reasan.,bie n�arket vat�.i� of s1�c1� itens must be added to t}�� ' �: � ='«sE
<br /> . � .�r ti.oncract price for pe3-mit fee pi�rP;�ses. In chc e��ent th�t tY�cg•e is a dispure on the amounf t�� �c�st,
<br /> - � '�,' City may request t�e sut�mjSSifiri OE d Si�[1Cd C<:,py of th� actual contract. _
<br /> i �- ` ; t:r is
<br /> � � ,;��� STATE SURC�IARGE is .0045 af ihe c����ract pri:e un��i��r $1,OOU,000 or $ 50.
<br /> � ���•ater. For va3uatio�s o���r $1,fl00,Q�0 cal! t�ic De��-�rc+1�rjit of In:pection�l Services f�;t rf < :. ,,
<br /> - '�1�a '.;`�si�ned hereby 2pp�ies to tl�e City fc>r i�si�:�nce of a Mechanicat Pe�-mit, > • .�: do ,
<br /> � in strict accordance wi the o'��it��;�c�=s of tt�e CiEy and tl�e re�ntlaiions of [t�� , � �, - ��Ea
<br /> a�� ; : �>_ , <<u�
<br /> �,;;n � r;s�iing Cale, and zrti es that�Il sts;t,�r����tts macie on this a��ptication are c� �._
<br /> ' .-•.c.t. �
<br /> at�--:
<br /> - Date: �t �:-�V�
<br /> • ture: - __ -----____--
<br /> ` P.'� ��'s Si ..__ , . _ v ---____.___ ___
<br /> xa.� �: -- - --� --_
<br /> -� ' Date: _
<br /> A, .�:i By: _ _.-- _ — �._-------- _
<br /> : .: , ` , ,_ ,_ �..�
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