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� ,/���0./�t���� Request for Reprints of Oversized <br /> � ' � ` Documents, Building Plans and Blueprints <br /> �s �' � � <br /> \�j' �/ <br /> \ ^1k;�,���,' <br /> Date of Request: 8 �'�8 ' �7 <br /> Document Address: BG.J �or�5f �,rrn S � <br /> Name: IUGI�"�..v �rG�.,b c.u- 9 : <br /> Address: gZ5 �07C�'�' �'rvl.s �.►�> <br /> City: /�(BU.�d State: Zip: 5.�3 (o � <br /> Phone: (o! 2 33 7 (o I 1 � <br /> (Work) (Home or Cell) <br /> Description of document(s) to be reprinted: <br /> CHARGES: All char�es must be paid at the time of the request, and are non-refundable. <br /> Requests must be picked up at the City offices unless other arrangements have been made. <br /> The charges for reprints of oversized documents and building plans/blueprints are based on <br /> the following: <br /> Cost of lst Prints � @ $ ,•�� ea. _ �• �1 � <br /> Additional Prints @ $ ea. _ <br /> Cost to Scan �@ $ 5.00 ea. = a2D.D � <br /> Special Handling Fee ��•V� <br /> Pickup/Delivery Fee 17.50 <br /> -� Set-up Charge 20.00 <br /> � Energy Charge 2.39 <br /> Subtotal b'8. z `� <br /> 7% Tax �v. ! 8 <br /> Clerical Fee 5.00 <br /> TOTAL 94• �`7 <br /> (signature) <br /> 2750 Kelley Parkway, P.O. Box 66,Crystal Bay,MN 55323 <br /> Phone: 952-249-4600/Fax: 952-249-4616/www.ci.orono.mn.us <br />