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<br /> APPLICRTION FOR
<br /> �i�'���f o���� lOsechanical Pe�rt
<br /> GENER]►L ZN'r'ORMAT20':
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<br /> 1. 1b.�a Mtat:y tt�t teu�I�.�1 ►a �.Matl�/ ►�(��� (:•�� • ��t •ll•eA�f.
<br /> INSTRUCTIONS ��•►t�c� �f[ •u.• •• u.� �►s�+t�t��.. [�.v.1a [w� ►�+••� (t�. ty� �.s I�t• i�< <tsu{���t.��.
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<br /> WALK-IN PERNITS AppGy a.t Ct.ty o66�ce:, 1335 Sou.th B�own Road (Cty. Rd. Jfb)
<br /> FiAI1-IN PERWItS Encloet 6ee - ►ta<C .to: P.O. Boz 66, Crtye.tcC Bay, Nrt. 55323
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<br /> JOB SITE 3�2 �
<br /> Ota�N�a/ f�►ai a�(I��ii.l ��c�r�tat�l� Ouia ..���L!��.
<br /> Owner's Name Telephone Number � ,�.,��;�
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<br /> Mailinq Address —� �t�
<br /> G�;y ln�r"��t�.;= Telephone Nuiaber ��/'� '�'�
<br /> Contractor's Name �I�f N � ,C L` - "r.;`
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<br /> Mnilinq Address L l.� � � �
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<br /> �I1111Mat/Lt If7o.00 qr pro�.cal
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<br /> •.���u�•.•�••...••....••..•.••..•••••.•....••..•.•.••........ $2 O.00A�cA uwlt
<br /> IWTi11G iTfTtKS
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<br /> �CONDSTIOMSNG r
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<br /> •�-�•�•••IN� nuve+�•l�u�eA oopY•o[•�l�s'• inac�li�clon sP�a�•l• $50_� �uA wlc �wod oo�iw�clon or�dd-a��fc
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<br /> wool acov�l�) y � `�ru�rlin, c:n.. 30'
<br /> �ruN Iiw �K..�3G� Mod�l Mo.�, 7ot�1 �
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<br /> ................................................................ Y
<br /> .......................................� a) Fasiuen[ial 520.00
<br /> �*�«*• �*t� ($20.00 minimum; $100.00 maxiawm) b) Commercial $20.00 Plan Aeviev
<br /> pu�G��ot M�+d��_ Mo. ot Ri��cs �
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<br /> rn.o[ �r.e.. c7 ..c. oc vi.,.. rw....a..•...............g2'00 per�head................................
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<br /> tc�aral�l, Indwtsl�l c w+ici-r..t1y ,« r•• scn.aul.
<br /> PERMIT FEE CALCULATION �
<br /> 1. Total of above Installations or Minimum Fee (%20.00) S
<br /> 2. State Surcharge ��< <►• s�.0 s�ua.,a c.�� o.�....+ sw��.w• c. �.�� r�*�c S .50 ,;.'
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<br /> 3, Postaqe and Handli^7 0. .[c ...ca�-t+ •vv<«•«•+•• �d� �`� ►°•c.�a `"i ►.+u.•� i•• S 1 00 � ,
<br /> 3
<br /> ^ adQ li.[• 1-3 abrs $ ., �,.� .�����
<br /> 4. TOTAL PERMIT FEE ' ��,,'
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