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_ _ _ __ _ <br /> _---- - ------ _--- <br /> __---- -, <br /> . PIIR'�tIT Fl�f; C'r�l.C't7LA�I�TON(S) <br /> �� T3,�SI�.D Of=F�- 2{)0? STATE STATLIE-- ----------- - ----; <br /> � 1 c�_ihi,accuon ap�ii�> <br /> !i�� r��larrmcnl uf a fl��;i�l�iitial_t_ixturc ui a� li_u,�c�that mc�ts till �hrcc��i tlic fuliu���in��rayuirrmcnt<: <br /> , t)u�;nut r�quir�muditi�atiun [u ciccu�ical ��r gas;er��icc. <br /> Ilas a ti�t.�l cuct n1�5>(1(1.(IU��r 1e�5: c�cludin��lh�coil uf the fi�iur�ur a��F�liaiic�: .in�l <br /> 3. 1> i�����r�����1_ in.tall��i rn�rc{�laccd b��thc h��mc��w�ncr��r lic�n,c�l c�mtracu�r. <br /> �I:ip n��t .�cti�,n. il�thi; ,y��ilir;:� (�n;t of P�rmit ti ---i�,(IU <br /> Statc Surcluir,�� J_ �.UO <br /> 11at1-In l�c�(ll�:�E,�lic;tbi�l � _ __ �_Uli <br /> "1'otal Ncrmit Fcc � — <br /> —___ ----- ---_ <br /> -----_ _---- --- <br /> - PERti11T F�.E C,�LCU�.�Z_iON(S)-.1C)I3S �)��'ER ti;00.00 � <br /> lt�ah����•�i��c>n��t a��nlc f�nll�i�r �_uid�lin�.h�lu���- <br /> I. COV'�fR:1(��I� PI21CM: * i� I.��`'���of co�ura�t pricr«�ith a(�linimum Fcc of S�II.UII) <br /> � Q :� � 01?; � ��� ' �� <br /> __— <br /> Ic�n tran�r�isi fmin�mum S�U.UIII <br /> �. S'1 1 C{. Sl lt( f(:112(.I'. � q'�s <br /> \� �`"r�n.� � .l)U0� � --- +-V <br /> r---- <br /> SJ�� -- <br /> � ����;,u.���i�:,,:�� <br /> • � � �c�n �Qttil-in �ppli���iti�m,) <br /> ,. I OSl�.AG1.� 11�1tii)LIV(� (()ni 5----Uli--- — <br /> �1. TOT.11. PF:R�IIT F�f�:F: (��d�i Li�nc; I-� Abu���1 � � �� '�� <br /> „ C�(�)�l R:aC�f� I'IZI('l ur IOi3 COS�1 mcan: thr actu;il ur �;tim.i���l �tullar ainuunt cl�i,ir�c�l fur �I�c <br /> � ��u�m�itt��l �r��rl: in�lu�lin_ matcri:�ls. lahar. �mti[. ,m�l nthcr flzcd cu>ta It i� th� :im��unt t�, hc ch:ir����i <br /> I�� thr cust�,m�r ti�r thc �e�ork don�. If a�i�� tnatcriaL �yuipn��cnt, labor��r in,tallali��n> ar: furnuhc�3 h�� <br /> th� u���ncr. trn:�nt ��r an�� uthcr par��. th�f rca;onabl� mark�t ��alu�� uf�;uch item� nnrt bc addrd !�� ihc <br /> ���im�u��1 cu>t �,r cnnn�art ��ric� fur ��rnn!t I�c� pur�,u;�;. ln th� ��cni iliat thu�� u �. .ti.E�utc un i!��• <br /> am��unt �,i Ih� j<�h ���,t. th� C�it�� ma�� rcyucst thc ;uhmi�sion ��I�a ;i�snr�i co���� ��� th� a�tu;ii ���ntract <br /> ___ _ _..—__ _ _ <br /> _ -- --- ---- <br /> —_ ___ ----__----- <br /> -- � <br /> —— <br /> MI Cf�AN1C',�L PEK IT APPLICATIO?�' AGR( }_N1E.N _______.__! <br /> �-- ___-_ _-. --- - - <br /> l-l�c wi�lcr�ign�d hcrcb�� .�pplic; to thc Cil�� for is>uanec of�a tilcch:u�i���l I'cimit. ��grc�� tu �lu ail <br /> ����irk in �u�ict :icc��rd.�nr� ��i[h thc urdinanccs ��f [h� C�it�� ancl thc i-e��ul,iti��n; ��1� ;hc Stat� ���� <br /> ��lii�n��<�t�t. .incl �crtiii�� that �ill statciiicnts r�ia�3r i>n thi� a����li�atiun ar� rumE�i�t�. u�ur �incl <br /> c��rrcct. <br /> S <br /> . ►�����: 3�I� -� -- <br /> �����lir�int � Si��natur�: _ -- -------------- <br /> ---- - <br /> 3 <br />