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CI�TY OF ORONO „ . � 6122494616 10/04/99 . 12:15 .� :03/03 N0:057 <br /> � � Woad.�.stove w�h flu� . . <br /> � �� �Foi�d cornbination or,�add-nn� <br /> �� Fact�ry �`iTep�ace witt� fluc � . <br /> � , . � �. �actary �ireplace (s) � � Freestand�ing Masonrr�+ <br /> . -_ �Vvc�.Stove (s) � � Nr$p�lin, oth�r <br /> : Bralid.N�me:: � � � IVlodel No. <br /> . . . �i�Ifgr's:Min::;.Cl�ar�s, side : :, ��r�ar �, miri, fku�d�ia. � <br /> . �� -��;`���'T�. I(y1�1 .. . . <br /> � N�t. � Kit�hen Exhaust �dwct�d recirculat�ng � cfi� <br /> � � '�d. .. �Bath��xri�ust. (must be d�ct� outside) ��,,,,. cfiru <br /> . . IJ�, .: Other F�ns: I.ocatiiin� � '�� . <br /> . � FUTY: STD��� (MU�T BE �►P�ROVEI� BY' FI� MARSHAL) � . <br /> . : � lnstallation � Removai �.: <br /> � <br /> �;�� �ue�;qil: ,��, gallons : �� u�uier�rnund ^ - insids oixtsii�e <br /> . . 1ap�Gas:: . � gallons . . � � <br /> � ott�r�� . . ���.� .0 . �.�.�.���� �as r� <br /> • • ��, •. �yc;l,.P� � z-c ' � •�S <br /> , 4.�ST vr c..t_ (1� l��C•o GP t.. Acr f o0'ZA t�+1� .—Sg� ATt Actt�A S�^T4_. �M.�-^��'�'� � <br /> �i R: r �-�.�rt��,� . � � � * � Ml <br /> �. � �;����r► O���p.��� �� ����-l���r.���,r . <br /> � .. 8�U0 .oa� X .OT2S $ �-t•SO <br /> � . � � fc6�it�'act.�rice) <br /> 2.. St�te .Sitrchar.a��.*"'.Add tt�e State Hu'ildirig:Cad� Division . <br /> ; Su�'c:�r��.tQ et�h perm�t. � ��o 00� _ x .00pS $ . 3 9t� <br /> . � � or. $.3Q; wlai�hever is grea�er (cc�ntxa�c price) <br /> . 3. �A�sta�c �nd i�i d�1in� (�nly mail�lt�.�pplicutiar�) $ _ .��. <br /> , 4.. "�U���..A�itMIT .�F� (Add li�� i-3��bave) � � oa•�.� <br /> * �QNTRAGT�l?�tlCL ar.1QB COST rr�ans the actual or�estimatcd dollar amtiunt chaige�i,tor the permitteci <br /> wt�rk i�net►iding matetiaTs, l�b:ar,,prpfii� p�d o.thos��xed�cos[s, tt i�► tho amount to.be chaa'gtd to the <br /> � � �:uatbmer for the work d�n�. If af►yy matcrial,�qu+p��l�bor, ar i�.s�llat�pa axa furnished by rhe awn�r, <br /> � �e�ant ar any othcr parsy thc re�eonz+blo mar'k�t val�c�af auch ita�►s must be added to the eatisnated cosc <br /> or co�trace pr.iaa fQ�pecmit��uxposes. Cri tba.event that rhere is a dispute on rhe amount of the jab cos�, <br /> . � .� the City�may request .ti�e sub�ussion af a 8igned capy of the actual contract. <br /> �** 'fihc.S'�AT£s.�S'(1[��HAI��� is �:0005 uf thc contract price undct' $1,00O;OOU 4r �.50 - whiciiever is <br /> . greater.. Far�aluacians ovcr $L,Op0,004 call.ehe pepartmcnt af In�pection�t 5crvica� f�or ctie price. <br /> �'�1� undersigi�d h�ret�+ a�plies to ihc �it3► �far �Ss�ar�ce o�a Meclianicai Pe�nit, agre�s ta d� <br /> �. � ali.work..ir�stricr�ccc��dacx:e with tl� ordina�es of 1� �ity and the regulatians of the Minneso�a <br /> St�t�l3uilcling Caciet ancl c�rtifies that a11 stat�ri�cnts made on this applieation a� ccrm�ptetc, true <br /> . . atid car:r�ct; <br /> � � 1� li��it's.5i re;. ^ �s�o z T�ate: ��I`� i `�9 <br /> PP <br /> t�pprpv�si�y:, � �- �3.ll �.e. Date:� I Q�7= 4�i <br /> � <br />