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. - •�ITY OF ORONO � 612473D51u 02/2:/98 13:57 � :03/03 N�:331
<br /> Yti��,?I�I�ti�_F�����'��'�
<br /> __._,� Wood stov� with flue
<br /> _.__ Wfl��d carnhinatic�n or add-�n
<br /> ��` Fa;cc�ry� fir�place with flu�
<br /> ,. „�„r F�►ctc�ry Firepla�e (s) __ Freestan�ittg Masaitry
<br /> . Wc�cx! Sti�ve (s) Frar,klin, ather
<br /> Eirand ?�1amc �� Mvdcl No. -------_~
<br /> l��ifgr's Min.: C.leacan4es, sidr __._,y reur� _, tnin, f3ue dia. _�—---T..
<br /> �:��'1L�7�'Y
<br /> No. __� Kitchen �zhAust ducted recirculating _ ctrn
<br /> Nu, --_ Bath �xh�ust (me�s; be ducted outside} cfm
<br /> Nv --- --, Qthcr Fans, Lncatrons -- _._._.__._._____,_ ____... cfm
<br /> �;�'� ' '' (Vli�ST RE APPkOVF,�3 BY FtR£ MAkSFI.Al.j
<br /> _T__ Ir�st�i?atian ,�_ Itemnval
<br /> _,_, Fue3 t►;i�� �__ gallorts _��_ undergrc�w�d iiisidr• outsidr
<br /> ._�....._ LF Gas: ._._� 8allc�nc _.r._
<br /> .__�..� �cher _ _.__.,_.___._�_ _._ Gas ��ening
<br /> ��������
<br /> i. ].25% uf C n x•t,�,�'" or ,'1�f,�q�g��j�,,,�„�1
<br /> —��--- x .0125 � ------`��J-=O°----
<br /> (cnntract pricc}
<br /> 2. �tAte Sur�;harti� M* Add thc Statt Building Cc�d� Uivisicn
<br /> Surchargc to cach pern�it. ,;6bZ� x .00Q5 $ �, �0
<br /> iFr $.50, whi�hevrr is ��eait•r (euatract price� T.�. r—!
<br /> 3- '�„�,i�;�,�n+ Han�lir� (Qnly rr:ail-in applicatians? � 1.50
<br /> 4. '1'UTAL PERMIT fi�F. tA�d lines t•3 above) S 5'�, So �
<br /> " C'QNIAACT l'R;C�or]t?R CGS'C mcuu�chc actual o;esfin�a:cd dniiar utni�unc t,harged for thc perrr.itte�
<br /> wurk inc�u�i�n� a�atetsafs, I�b�.:r, ptutet, and aher Fcxec4 c�x►ra. Ir i� the amauj�t to be chAr�e�! tu ¢hc
<br /> custozr�er Por ;hc wiak do�e !f atiy i��renal, cyulpment, iah��r, ar insea�!at.on ate t,�rcilshec by the awp�r,
<br /> tonant�r any other party the reas�uc3ble :n:�rke� veSue uf s;}ch item� must be �dded to cht catimatcci cosc
<br /> ctt co��tcx�priCt tor�xnr.it ftc pur�ose;. in the everst thac zhere ss a�lispuu oaa nc� amount oP the�ab cost,
<br /> the C'.ity mny requcyt the �ubmission ��a aiyned capy af the ac«:al caniract.
<br /> "' 1';:e S'TAT� SL#RC�NAR(3E is ,OOL�S of ct�e coo�raci p�ice under �1,OOU,lXtO or ;.SO • w�ic2�cver i�
<br /> gren�er Por vul�R:.or,� over Sl,O�}Q,000 cnl� �he Dep�rtmeat nf Jr,�pr.c;ior.al Scn•ices for thc pricc,
<br /> 'I'he undersigned hereby app}ies tt� the Cit� for issuaxe of a Mecl�anicai Yertnit; agrees tu do
<br /> alD �vork in stri;;t at:cnrdance wich �hc crdirwnces af�he City arx� thL �egu�ations ��f the Minnes�?ta
<br /> State Aui�dir� Cc�de, Rixi c�rtifies tki�c a11 st�tcmrnts mac�e on this appiication are cumplere, true
<br /> attd Cc�rrect.
<br /> Appiit;ant's SigJtt�tutt' � �ir �.'�l/`� 9
<br /> ✓ _ ..._...7...._,._.��4,�---- �ste: .._... .._„�
<br /> Approvoci By; ....._..,._.,,_.w.,.., .............,..,...__ Date: � ��J
<br /> -»_.._..._..._. _
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