|
- i�,.iRr��La�..Ls�-
<br /> c�G�►.ti Fac:l��ry tir�plac�
<br /> ^ Wood burniu� facto�y fic•�place with tlu�:
<br /> Wor�ci St�ve
<br /> ^_ Wnod stc�ve with tluc
<br /> i3i•ar,�l Nait�c .. ,� Mi�ciel No, _ ., _�
<br /> VI'NTII�ATIQN
<br /> No. �{i[chen �xhaus[ ducted ri:�irculatins cfiz�
<br /> NU. �' "•�•'• ���,•����� /���ucr hr ducted �u[slde) Cftn
<br /> No, _ 1�``� _....— �fiin
<br /> ,� __... --
<br /> 1+UL+:I, ST(�R�.Gi, ( � ,�� a� � (;� . .
<br /> ��I n.�,, r�1�AL)
<br /> Insta111[ion Z,� �� ,, '�
<br /> �
<br /> _.. Fuel c + L!' t � 1� � ,.� �,�(,� '� ir�side ou[sic1�
<br /> .� I_P C'• A � � (� ''t� �,�, ' � -
<br /> '` V iJ
<br /> C)ther r� �\J� � � G' Gas op�riir�b
<br /> ��4 � ,
<br /> Y�RMIT_1���:r, c��_ � �� ,�y,1 � � �
<br /> I. 1.25% of co . �.,� , � � ��
<br /> ' C � � �'� ``� U 125 �
<br /> �;�' �.'L � ��
<br /> -, -��. � �� ,�' ��)
<br /> 2. St�ue Surch�t �, �� C,, �n `1�
<br /> Succtiar�c Ca 0005 � __,�___ ..,,.....1__:
<br /> c)r $.5O, whi__ _
<br /> � ��
<br /> 3. P�itit�lL!C ;u�d �-I�iL1C�I111_L' (Unly n�►ail-in �I��(�IICJ[IUnS� `� 1.50 /�f�.
<br /> 4, 'C'p`I'AL 1�F12MC'1' FEE (Adcl lincs 1-3 above) `� J✓�'�'� �D.._.—
<br /> � CONTRACT PRICI:i or 1Uf3 COST n�eans �hc actual ur escima[ed dollar antouut cli�rged i'�r thc ��cruiitted �,
<br /> wi�rk inclu�in6>>1,U�:t'i�is, lahor, pr�tic, and other tixed cosis. 1� is thc arttuuitt to hc ch;•ir�;ccl lt� Ihe custom�r � .
<br /> for ilie work cl��ne. !f ar�y ,naterial, cyuipntcn�, lab�r, ur installation ar� f�u'nished by �li�:uwncc, �e�la�i� u�,, �?
<br /> �ny U[hcr pur�y tl'ie reason,�hlc m�rket value of such i[ems mus� be added co thc es�imaecd cost �r cont���ct %
<br /> price Fo��p�rrnit f�c purposes, ln�hc even( that dtCte is �disputc:on tlic £IIiIOUnt Ul ll1C JO�COSI, �hc City ma��
<br /> rcq�lest th� 5ul)missiUn uf ri si�ncd copy of'thc �ctu<<I conu'1ct.
<br /> *�k 7'I�e ST/�TE SUl2C.l-IAIZG� is .UUUS oi ihe conu�act Pricc under�1,OOQ,UGU ur �.SU - wlticl�ever iti gre�t�r.
<br /> 1=pr v.�luu�iuns irvrr '�I,UUO,UUU �all thc Drpartmunt oC Iilspec�ion<<L Scrvices For �he pricc.
<br /> '1'he undcrsignccl I�►ercby applies to the C,'iry For issuance of a Me�hanic<<I Permi[, a�cees co cl�> all
<br /> woi'k in sCri�l �l�coi'clani:i: with ll�e ui'din�ine�s c�f th� City ari�l tl�i: re�ul,�tiulis of th� Miitnesi�c<<
<br /> Sta�e Buil�liia�; Cc�[le, ��tul c�r�it'ie5 Ihat all s�t�Ie�t�ents m��cic: on this �pPlicaiion are eoit�Ple[c, tru�
<br /> and corr�c�,
<br /> Applicar�t'sSigna�urc: �__��,.��w-i --�����"�� .. Date: /Z"S��
<br /> APE�roved 1�y: _.. _ ._ .. ,^ Dale: —..
<br /> i
<br /> I
<br /> I Td Wd6S:i0 z0az Sa '�aQ 9bbz z6b ZS6: 'ON Xd� 1d�I NdH��W H1f10S: W0�1�
<br /> �I �
<br />
|