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a12-2�-95 11 : @2 Wood.bury Mecha.nical ID=6127707313 P . 06 <br /> Vl I f V� VKVryV � 01tL474G10 itl��/7y V7.aG �y .V�/Va I�V.wa7 <br /> 1 1.�5 Y� ot' + or .".z:+�;.�...�», Fr�e 5.00 <br /> • �oU x .alx5 � <br /> _'�(ooa�raet prlcw) <br /> 2. ** A�dd tb� State Buudi� Godc Division <br /> Surct�rg� t� �ach pcimlc. x .04�� � <br /> (wnu�ct p�ioe) <br /> or �.��, whlchav�f is greater <br /> �. ' (only ma�-in epplicatians) � �y <br /> 4. TnTAL �'ERMY'T` FE,}? ' (A�tld l[nes 1-3 above) <br /> * CON'rRAC"T PRI��ar J��C�3"�mc3ns she tcni� or�stimxted dotlar amotmt chtrgcd tor tba pcYmicted <br /> worSc ��i�d�a� m�►res�ial;, labor. �tOtl�. � olhwr fi�td cQ:ts. !t ia the u�usu to be �h�rs�d to th� <br /> cu�iomer for tha auoric dona, lf�y�iGrial, °4�Dment, la�box,or iastulatian are tu�aishad by cho ownar, <br /> ten�t or aay ackur v�►rtY �c rea�nnable m�ricat r+aiue of such i;crn,s u�wt bc added ta sha ectl�rnced eo�c <br /> or taontr�et prlc�tar psr��It foe�c'pe�e�. in the�rrtiut W.��hcro 1a 4 d�sp�u=on s�4�4�e af d��e��o.t, <br /> tha �4t�r �v raq�teat tha subrnie�lon ot i atgaed copy of tba xatud coatract- <br /> +* 1fi� 5'FATE �URCHARCt�s � .004� oi tbre eanuacc pticc uader S1,Oda.QoO ot S.� - whtck�ever is <br /> �re�ta. �or vahutlnn: mer �1,OOQ,OOA c.�t use DcQarxma►t af lasgeationsd Set�+icea foc th� pt'ice. <br /> The utndCTeigriCd hei�tby mppli� to thC C�ty fOC iSsuttncc of a Plumbis� �'la o�� of the 5ta e af <br /> wark ia rtr�ct accc�rdgr�e with th� nrdi�.n+ces of the Clty and thc tcgu <br /> Mi�es�ta, �nd Gertifies t4at al� ata4emants madc on thfs applicatlon ane aompleLa� tz�uo end <br /> corrcct. <br /> + ___ ���.�-� Dat�: ld — �� <br /> Aprplic�nt ��i�natt�re; <br />