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�_I'�' FE�; CAI �' 3 ' t�y <br /> 1, 1.25°l� of C4�ltr�ct.�'�".J<��* �r �,':ll�.l�l.l�i;�.�'��.44� <br /> ._.�...�a�_..._..�.��''L>�"% x .O l�,� � ____ <br /> (CO(1tCiiCC �lC1CC) -._....---.--�_._T_�. <br /> Z• �� ��r�,g�, ** Add tlie St��.e B�ildin� Code i�ivisian <br /> ' .�urcharge ta each permit. mm�. ____� �T,. x .(�,5 $ <br /> (ccr�trat;t price) .._ ,...,_...._.�.�.�._......�..� <br /> ��r $.50, whichev�r is grc�ter <br /> �. L'Q�tl�.���lAS (Qi��y mai!•;Ri a�pl�catians) $ .�._.._.._..L�... <br /> �. �'p1',A.� PEItMI`I' F�E (Add li,�c:� 1-3 abave) $ <br /> " �"�N7'�tAC'T PRIC�o�.1QB COST�neari� �: e actual or estin�ateil dollar amaut�t 4harged fpr�he permitted <br /> work includin,� matcrir+ls, labor, p�afit, ai d ��[hcr �xed cost9. !t is the amount to b� cl�argcd ro thr: <br /> customer for►hG wc�rk clone. It any muter�ial, t�;:ttpment, Iabor,c�i•inst�llacion are fiirnish�:d by che awner, <br /> tenanr or any athcr p�y Ihe reas4nable, �nark��r value c�f s�uch items must b4 added ta thd estimr,ted cost <br /> or�untraGt price tor pr.rmit fcc pt�i�ose:- !n ��;;venr th�t thcre is a dispuie oA the:atnc�tuit of th�j��h cost, <br /> thc Ci[y tt�ay reyuest ihe submission �, a �i�•�:� � :opy oP the actual contract. <br /> ** The S'�'AT£ Sk1R�:EiARGIE t3 �Gt�S uf the �.;,�tract pric� uuder $2,OU(l,Of}U or $.5Q - w�ichever is <br /> grcater. For valuatiar►s uvar .�l,l)OO,O ,Q cail tu� bepartment of In:cpectional Sotvices fQr the prlce. <br /> The unc��rsigned hereby �tpplics ta the C ity fc�r issu�nce af a Ylumhing Perniit� agre�s ta da all <br /> wofk i� stri�t Rccordance with the ordix��ncca af th� City and the regulati�ns of the State uf <br /> Mirira����ta, and ccrtifie� that all statemcnts ;�aac�e nn this applicatiQn are coinplete, true and <br /> t;c�rre�t. <br /> , <br /> �.pplicant's Si�nature: � . _...�.��__�,.. _ _ �ate:��� �� <br /> % `, <br />