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�� " �, v.•v,._ tly � .r�. .. ._ '_ __' '" ' __ '_'_' . , '__' __ ._. ._. <br /> ' • . • . ' � � � <br /> • ..�ia4+f LAC� . ' ' � � <br /> Gas ft�:u�ry tiieplacc . � <br /> Wo��d burning factory fire�ilace with flue . . <br /> �f� �fOYC ' <br /> � W�wd stove witl�flue <br /> . � � DFttnd Nam�. , :� . � _ Mcxfel N�. <br /> � VEIYTiLATI4N . . <br /> i+�o:. . Kitched Fxhuuyt ducced recirculating cfm <br /> Na�. _ Bath �chRuat (r�ust �ducted oucside) cfm . <br /> Na. . __ Uther Huns: i.ocatiqns cfin <br /> :FjJ��. STORAC=� (MUST BE APPRUVED BY .Flltr MARSHAI,) <br /> �3n�tallation ' Renu>v�1 <br /> _ Fuel:�il: : gallony' underground inside outsic}e <br /> � -- I.Y(3Ks: ` �attons - <br /> Othe:r _ Gas czpeiung <br /> . �' ���R��'I1',���SULA�'If}N . <br /> 1.. I.ZS% uf Cc�ntract Price* �r 1Viiniinwn Fe�S33.00) <br /> �'�' G C', � x .at2S � � /����-�— <br /> (contract price} <br /> 2- �Y[c�{�.St�1i►lf,g�, '`*Aeict the State Buildirtg Cocit Divisi�n <br /> $urchargc t�i�aeh permit. _ - x .00US ' $ �,5`'�.� <br /> ot $.50, wfiichever is grcater rrunnacc prlce� <br /> 3. �'��stagc �nd 21ac�i�li�� (�nly mxil-in applications} � j��0 <br /> 4. TQ'CA1�YERM�T fF� (Add 1i�its �-3$tx�vej $ r f e1,� <br /> � ' CONTRACT PR{CE or)OS C(�S�sneany Elt�ec:t�ra!or rstirrfaud dvJJer$rr.c�unt eherged fcu Ilte pr:ruittrd <br /> wock inciuding macerials,tabor,profit,azuf rnliet fixed cosu, I�is che aniaunt to be charged to thc cusst�mer <br /> ' far the wnrk d«�Ne. I€aay maieria�, rquipmeni,)xbur, Ol tII6i8llaEif�lreflJ712i.Yhcd by Ihe oWncr.unant or <br /> � any other pacry the ressonabfe mnrkec valu���P iuch items must bz acitied to ihe c.stimate�i coac or cwttr�c� <br /> �iice.ttu permit fu.pur}uises. In rlu evem tihaE�#ierc is e dispt�te c>n tbr anx�unt of th��eos�, the Ciry may <br /> ' . request �hc SuKmisaion uf a signrd eopy��f the aotval eomract. <br /> '* `l71e STA7F S111tCHARGF i.r .00()S of the convact prier un�ier Sl,WO,tI(�or �.SD• wh�chever is gren�er. <br /> Fc�i YAIU4Lioi1S clvCr�1�OQO.DW cal!the Dcpartjnen�af Inspeccic�l Services tiii the prica. <br /> Tht uncirtsigned hrreby app�ies t�chr City #vr issuanc�Q#'a �L#ech:�rtiea! �'ernt�t, agre�s to c!v all <br /> work in strict`accc�rda�ice with tl�� «r�linancc;s Qf!he Cicy aizd the r��ulali��rts of the Minnesata <br /> �tate t3ttitding Code, nnd ce:tifiGs that afi statements made an chis appticacion are cumplete, tru� <br /> ar,d corre�:t. <br /> Appltc�nt's Signature: � � <br /> �r���' - 2—c �3att: �, ,_ <br /> � _�..._ _ �� <br /> Appru�ecl By: J /� �X�.� __ �; � : � J�'� <br />