J11L, -1�}' �►9fh�i0N) ll : irh R(�BERT B H1LL CO3 TEL� 61? 9?5 14�1 P, i�iy�
<br /> y� � ,.,,.,.,,z�
<br /> . � ' . , , i . , � � ' . . � . . .. ,. .'.. .I .. , .,�' '.y�.. ''�.,i-:�f�:" � � �.��i P y��}sll� � ��r ���:.
<br /> . . •. . . . .. . . ' - . . .. , - , i, '. ���fk^�r `�� 1��i' �i�� � �
<br /> � '(., ' , _ , . , _ � � i ._�� �v)1�� ! � ��i������1 i�..i�����,,
<br /> �4i � �`� '-n� I .
<br /> ",: � � � - . . �` r _ ' ii i i u���ii��� � 'l:`3�1r i i,.i :�-
<br /> . � � . . .. . � �' '" '1 �C` -�' 1
<br /> _ rF.�Ir�r J .bAd� i ,��.
<br /> , . , � . , � � � � �,���
<br /> ' ' .i.' � 1i��. . � : �i ' f' '��'�i,tG�{i'�li�d IT ' i'r.',
<br /> ' . � rI+'EE HL �11 .,' . .. Y 'r,1 � .. ., � .� - � . . � -{-yrk'.�-1�.,�����'�.f�:NY� ' r� �,
<br /> �' 1. �.,�.��1`'25°�"of'Contis�'�P " ' �����,•t ,�.m'um�x'ee (9'►35 0�) �!F a r r��` ' � .rr
<br /> . ..; "ce*or 11�-- , ,,,/��C �f � " C, , .
<br /> ... .. . . . . •. . �1 ' �I �. o�4J�iT�/ ��T \��ryT�r�-A � � � II�T�� .�I
<br /> - � ' y .r �Y
<br /> � ' ' �i�T�¢f� �• �l�„�
<br /> � ' . '" •(con�aac price� �. :. ' ' ` -�.��„� r .�_ � ' ,��� „�
<br /> � � ' 3r2: , 4i,
<br /> 2. State� urch � c. ** Add the State Building_Code�Division . . r�4;k:;:��""�� k' r�' �x��
<br /> �. . � 'I� I 4.11 I
<br /> :� �8C$ ITlllt. � . _ „'� ]C ''Q005 x��d,i���' �"'��<"'
<br /> Surcharge to .,pe In : �. _ �._� , . ;�-.,.�,..,_., • �, ,,.K-�,.,��_.
<br /> �4- �'i'.��'r,_ . . . `., _. :f�1�:5�4 �!��.�. � � ':l'':� ,t� � , �!?:4.1.�.i
<br /> � r r.i! COI1tr8CL �.'e ..� Y,�• " - �::�'�'',j�' , Il.;
<br /> ,A ..r..,�'�PTI�"i-'�i`i� "(�: ,,,, - I'� ��x; � :. ��•'�� rv,', a;�r!, r, ,r('i; .
<br /> �. �l S�- � ;'.:�• ••d6,�4��'�,[.1�t 1 -.1:�'�_:�iY'/�-})liJ���+iSfi fiY�➢� i fa�,� rir' '�; ��i�,�, G�
<br /> . . �r'.. a�Sp ::whichever�iS��g�PSLCF:..� _��.. "y.e_ .r� ����� .:f'�' �� ° ��,f ' %��:��'��.t i
<br /> '� ..- _�►�._ .,.f- • - -- -=-_.�. . .�_. _... r:.:- J� �?f , a�,1•�$Q?�.
<br /> 3. PDSt3�e and Handlin� �Only�mail-in apAlications} , . �:�,`: ,,$ . � � ��:=
<br /> ta �.'.: .��;:.� �°• •y •k:,T.,•
<br /> 4. � �T�OTAL"�pF,gIvIIT FEE• :,T�(Add�:lines.;.l;3:above) ;� � � -�,;�� $,�:,��- •„�. a��
<br /> ."il',:1;d`.y. �f' �.ISS �� •� ' ��, �
<br /> : ,.. . � ._.,. . �..•��,�;�r..�,
<br /> : ' . . _ . :, -'`l,�'���:��i�r+�"�
<br /> • �'COI�TRAC'T�'RICB or 70H COST means the actuai..�r�timatod.dolluc�4untcharged.,�or.��h'e' �,,.�,�+� .
<br /> work includiag materials,•labnr;�profit; and-ocher�fix�d�.casts.�.�.,Ii�i����e�:;amotint�,ta,berwc�a.i'�,ct��°- . _
<br /> `���� ' ' ui men labor or.installatian are furnishcd b�+th�'owner. .
<br /> ., ... .... _. ,
<br /> .. :. .. . � t•4':i�'�,..-.�. . ,
<br /> . . customer'foi`thc work done: =If any.�atcnal, e4 p _. t;` ��, ,, ���,�a• r,,
<br /> tenazit or any OtliGr Party the icasonable market value..af such itcuis.m�t be added to che.e,�Eipae 'ted�.,�s� �,:;Y
<br /> �..,.
<br /> o=contraci'pric�for permit fae`purposea.-�In the eveae'that�there is a'dispute,on tlie amount af the�Qb''c�ts f,� ;., .
<br /> f a si ed co of t�e sctual conuact.� .:��".��•:��•' -
<br /> �the'Ci�y maY.request the submissioti o . � PY_ ._ . _.. . ..._. �_._ .' . ,:�:.�.;:��s.��c�-;.-�.�:� ..
<br /> ** TtiC S7'AT'E SUR�HARGE is .00QS of the cvnct�ct priee under $1,000,000 or S.SO = whiehe�'er:�is
<br /> .greater.•�_For valuations ever.�1,0OO,ODb call the DepartAlent o f Inspectional Services far the price.
<br /> .. - ._ ..._... � . . . � '�`� . ..... :;,�:'` „ �'`, , . tz �.��;��;� :::�:�- .;
<br /> 'Th� undersigned hereby applies to�ihe�Gity for issuance of+a�pliunt�ing_�+ermit, agrees to do all
<br /> wo�k in strict,:accordance with the ord"u�aaces .Qf„the City and,�the,regu�atibns of the State of
<br /> 1�ixanle`soia;-. aad ceitifies-that�a11'st�tements i�iade�;_on'�_��liis-applicat�on.are_complexe�:;tnie��nd ',°
<br /> ��.�` y� Y� 4:�4i' •� �'^', �- ' : .•�. �.. . � -�`..11��l �'� +T�� � •- -...�.. �;I �� �A .�.,'
<br /> . ��e.C. i'..y', . . � y, "!]^'-r-.r—" .i
<br /> r. yp� �
<br /> _ ti_ .:i`� '` _ --��,�\y - 5--,��� (M�,,;'�-��-�'C�+ 1}�, �.i��'��.���1fM.`°'ff iYxl'-�'
<br /> � �,`._;1��.�^_4"`_� . . , - � �`�_r_ir -- �— � :� . , '' �^'�f �
<br /> • � *� f *� ` Y I.J �i'-.'��
<br /> _ �.�, -,.�s . - , �� -,�. �:�, <,� .��.�. Date•I , f,t�d:,� ,,., . ,
<br /> Applicant-s Signature: .. .
<br /> _ _ . . - - -, : .„ . . . � �
<br /> . ., . ., � • ^i_. , -- . ' .. , ._.:"� ; �. i c:�s.:',:"�. .
<br /> ,
<br /> •'s �t � i � ' �l:-
<br /> ;r.,-cr..:.;_. :,-.'ra.:c r:tmm-�a. .... � �. � - r ' � - _ ,
<br /> , I , ,. � '--.:.7Sf . . . . . �' �:'_....... ..--"--'. ..._. •,. ' .,._.�.a. . ... . . .. �- '�4i:�►Sa�t.^+ ...
<br /> .
<br /> . � � �••�i-�
<br /> ; 7 , . � ,'!' ���,�� ,
<br /> �� � � � : �.-�_ . � -. � ?��"NS4;:'�,
<br /> ..
<br /> ..., .. ._ _._.....�......_..�...�.�.�-�d._.._.._ .... . . , .�,... .:,:.y 1-._.•. -���_..�r'�-� /� +- - ' �y . . � .
<br /> �
<br /> ,
<br /> . .._._.. . . . .. '-"'- --- - ........._. ._.._ . , ,
<br /> _, ;�, i'.
<br /> ' . : : . ,.- � , . . . .i.}al� ' , . , �.
<br /> .. . . .. . � -_. .. ._�y , �. _,I_ �•..... . . ,�__.._.. � ., . _.� - .� . ... 1 '_,-. � .�.-..��.��r�l,^, . . .
<br /> _ . ' ._.. � , � ' ' � � . L+'p':' ' ,
<br /> . . .. _... ...5_. . . . .. _ . ._ _. . . .. .. . . ... . ..""' } .. . . . ,-.�h� ....� ...._.�� .
<br /> i r
<br /> ...... . . . i ' '.:� ''r -:
<br /> .. � . . . , ' _ ; .. . . ._. . 1,:�: �'�Sl(i .
<br /> �
<br /> - . . .
<br /> ..� . . .. . _ _ �
<br /> _ •� r
<br /> , � -,_..... _-.. . � . '
<br /> . . _ _ • r _ •"'_' . � ........�. .�.... ��.w� �.,
<br /> � . � .._ . . ...__. . . . . � �,''.,�i Y',��1. .
<br /> . " . 1.. - .. .�� .�.-.. ' .""__ � . . . ,..r.h�.��.1'1_ .-..'"
<br /> � ,.... . � . _. ' � � i �'�J'::�'H��M1�% ..� ..
<br /> .. � . , .-.': ...�_,_. _I . . . . � ....., �w..'��_..._._ ._ ._.. _ .. ...... .. . . •' '.,...� I.. �._..�...... _. �� .r• .tt;i'�''G.F>16,��: , .. �
<br /> . .� ' I.(�: : I .�..
<br /> � _'--.,mwr�.}n.�.. ..�... . , � .,. .,�. .-�. ,�.r1... i1��S�� ,-. �.� � . , � '� ,'1' ' �'':I.,yuT t1�-T:F .
<br /> . . .. .. •fr,_. . . .__,... , , ,..� .l� .� � . . nd y�:. -
<br /> " � . . �� . ..__ _. 61� �I�dil.'.. �
<br /> - I 'i_
<br /> J I �
<br /> . . . ' � . ' .. �4.-._ . . . �� ���1�� �4� _.�'..��:.:��� • _
<br /> . . . .I ' ' ' . . . � ... d..".�'.:.ti.�•. :,:�.. +
<br /> „J�. .1.. �i�l.lr�"�.�� I.
<br /> '_ " ' .�.. , � - . - . . � .. _ - _ .. . _" -_ _���.�'tl=.���,..: ' '
<br /> . , , . '.1:�', . , . " _ . _.. . , "' _ ' . '" �_ .'�1.:":. ' - .... � .. , __..,I Mn:i��'•^�,C iY.�:�;�-".'..'�'k'��: .., �
<br /> . . � . .. . . . . ._ ... . � r�..�� . .
<br />
|