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� , =� �i�ur�U � 6124730510
<br /> 06/08/97 11 :41 � :03/03 N0:158
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<br /> �- Wc�od stove wirt� flu� ���PrA.~C�(�}��iC�C� I�t�c�� i,��f�
<br /> in�C r��'�`�
<br /> ._ Wo��d s:onibi�t�aGir,n ��r adcl,on �r��G�.C�� '�[�� I,l_.�--� S�{a�-�1���� �rn2�
<br /> ..___,. F�ctory firPplace with J7ur -�/�c>r� Sfd•�� �}-z> �� � �lar►�`�/ �' ne�..�
<br /> ---- Factor.y T�it�eplacc (s} F�•eestanciinb Mason �� tJ'�
<br /> W'c�oci S�c�vc (s) � - ,_,_„ �
<br /> - F�ranklin, ot1��r� ,
<br /> f3r��n�! Name , �,�1 _.�_ -,—...�.. �_�
<br /> Mf �r's _-�-Q`�-1�C.s�1�.:�. n� _. ......_.�_ Moc��1 N�,�;,��t.�� ' ���r�,_��,:�-�1) -��,�'r,,:;
<br /> �, Min,, C,learances, sicle __... , rear _ _, min. tl;ue di�. ✓
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<br /> �:��.1:!'!t a.,�"�'L�L�'
<br /> ���• kitc:he�a Exhausr ducted reeirc:ul�ting efm
<br /> `�''u. __.,__, ���t� Exh�ust (uiu�t he duct�.l o��tsidcj �fin
<br /> N��� _.,__._ nch�r Fal1s: L.oCattorlS ��
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<br /> �':1,S'� ' � (1VICJST RE .APPl�C)VF.D BY F1,k�: MA�SHAL)
<br /> f ristdllati�m Removal .
<br /> __ l�'uel oil. _._�.. gaJi�ins _ lit�dergrounci ins3dc outsidr
<br /> .....__.._ I,P Cia�: --- �allons ----.-- _w__._.
<br /> OChrr
<br /> --- -- ______ —___-_......--------_..___.._.�.. . ....._ Ga� c�penin�
<br /> �It11�1 � F��.�.��:��
<br /> '- . 1 .25`I� of' �.�.1�!'�1.�.��.'.�1��* ��r ���L " . `�.0� � .
<br /> zS x ,0125 $ `3S �z:
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<br /> -; c ucc �,riec �
<br /> �. 5���ur,��.�:�: *T Add rh� �tac� Huildiiig C�ode DivisiUn
<br /> �ure:h��r�,e t�� ea�.}� per»>it. x .00pS � �. Z�
<br /> ��r �.:�Q, whlCllEvc;r is �?re�ltCl' _-(cuntr�cl priG�j �. -..T_.,_,T.,,,�,,,",...."'."."'.'"�
<br /> -�. 1'�is[,��_'��. "C�1_li� (t)nly i7��►i1-i�i applicati��ns) .
<br /> ; '1'UTAL; P�RMIT FT:F., , � -��-�---- 1-�-�5-0
<br /> (AcicJ lines l-3 �h�v�,) --� ..��--
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<br /> ` c-�ONT'3�AC'T PRIC}:c�r JQf� CUS7' nica�u �1ic; uc�ual c,r estim�ted dolltir Arnopnt eht�,��d fnr the permitt�d
<br /> work fpC�11CI117g t111(L'Ci��is, lsisor, prntic, and other fixcd costs. lt .i� rhe n�nount ta be chargc;el tc� tl�c
<br /> �',�s�c�mer fc;r th.e wc�rk donc. if�ury �natcrixl, c:c�uipn�n�, labor, or in�tallatiar�Are !"�rni�hed by the uwncr,
<br /> �r�;;,nr or ai�y other party tl,c rr.asw�at,��, rrl�rke� ��alue Ui �ucl� ile.ms n�ust b` added ro the estimated cavt
<br /> ��r ��,c�ntracl prict ft�r}�ermit fee pt�rposes. in chc cvzne rhlt daer� is a d�sp►ito an tho amoiint of d�e JoU Gast,
<br /> ��'< <'��Y »>uy rUy�zcst clac submission of a signecl cop�� Uf lhC ACIUaI C477Ir1G�.
<br /> '- ;i,r- STATL SL1RC'HARGF' is ,OOQS oi �hc cc�ntract price uiidec $1,QUp;UfX} uC �.50�• wllicheYer is
<br /> z,re:aiar. Fnr yaluatipns o��er �;1,UUi),D()p ca�J �he pep<��crn�ni o1`In�p�Gtionai Services for the�rice.
<br /> '1'i�c urti�lertii�nccl hea�ehy a���alies tu thc Ci�y fur.Issuanc� of � 1Vr��:k��ct�ic�1 Yermi�,
<br /> al! �z•��rk i>> st.rict. acc;c�i�ciznce with tllr c,cdi�3Ftnces of che �Icy and tli� regul.atiar�s c�f tEie�Minne;sc�tQ
<br /> :�tate T�uildir►� C�'c>de, �nd eerrities tl��t �iJl �tatemetZts i�1�i1G c�p fhis appli�t�tion �re eU�:nplete, #rue
<br /> .�u:, �ur��'��:t.
<br /> .�pplicanc's Signaturc: _� '�
<br /> _.........._ - — ° —_�....� --- ,.�._.._..... �at�; 'T�1��
<br /> ����j,�:,����1 tsy� .
<br /> ..._,._..._....___..� ___..�....____ ..,_.._..,.�... J:�ake.
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