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� � CiTY OF ORONO � 6124730510 11/16/98 12:Oz � :02lOZ N0:114
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<br /> 'WqAd �t4'V� With flUC
<br /> .,,�,,,_�, VVaod carr�biva�tion ar addMnn
<br /> ,��, �'actar�r �irepkace wi.th tluG
<br /> �,.,,r._. �acto�+ Fire��ace (s) ___w_T, �ret�tand'ln� � Masanry
<br /> '�c�od S#ovo (sj Pt�k13n, othex
<br /> �rand N�me M� Model No
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<br /> Mfgr"s Min., Ctcara►rocrs, sick �..�;� rcar�, rni.r�. flue di�.
<br /> Y�.�I`,���T'�Y
<br /> N�. �� . Kit�h�n �xhauas � duct�ci recirculati� � c�m
<br /> No: _.�.r.� �iath P.xhauat (must be ductcd oatside) � ��
<br /> Na. .,_,,..�.,�. �tl�r Far�s: Lacat�c�ns ��.� cgm
<br /> �,.s�,�',��GF (�1ri�'ST B� A�'F�OVFA $Y FI�tE MARS�iAL}
<br /> ....�.._ It�st�lla�i�n ;.....c.a,:, R�maval
<br /> �. �uol 011: ��ilkvns � u�derground i�sic3e nutsidc
<br /> � L,P Ces: r � gal�ans
<br /> � � � � ���lfGr� (.rtt� ' ' y �. .. , . .
<br /> ..,.`� a,�, _ . c1i,� �j��rCrCt'�tin�i7 ; � ..,, ��� q�3Ci13Ilg
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<br /> �'�c�!'1.��,.�'���.G:�.�i�I �,�r,:,�;r.c- — J - �c��c .r��tirr�.;.-�'r
<br /> � � 's�,-, 5��.�1 - � - y���o �/��'
<br /> 1: ].2�5� aif ' ar �um �e�e [�3�.�001 % "`�'�'i
<br /> �f aoo x .41x3 $ 3 i�- . �"o
<br /> --..., .�,._._
<br /> (contraci pxiaa) , .
<br /> �; ,��a��1��,� ** .A;dd thc State l�uildizyg eode ,Uivisian
<br /> , Surchar$c tq �ach ,pert�ait. �.�, G � t� � x .4UQS $ �� ���'
<br /> rar $.5a,;w,�ic:hCv�r is grcat�r tcoauracc prlcc)
<br /> 3. �'�.���i� (��ly mail»i� ap�licatians) $ �,.,- 1,50
<br /> 4. 7'bTAi.'rE�R�!C'iT F�E (�,dd I�aas 1-3 abovc) $ ��..�, �o
<br /> _�____.�,�_
<br /> * C'C���"�:�q,�''T�Et1C�:ot 1�18 C'OST means tlace sctual or escirnaocd do11m•emc�unt char$cd for�►he pcc�a�ittccl
<br /> wark inclUd�ri� matcrii�llY, l�bor, pro�lt, and otk�er tlxed casts. Tt 3s thc grnaunt tc be cha,ic�ed ta the
<br /> cuat�mer fpr t�work donc. If u��+ muaerial,'equipme�t, lebar,or ir�u�flacion ard furnished hy t�r owncr,
<br /> te�at�.t or n� o��,ox �arty thc cca�a�able m�atket vsluc of such itema �nust bc addGd tn.��patlsz�ated coat
<br /> ar car�tra�;t',pr�ae fior patr�t f�putpa��stt�. l�the evvc�t t�at d�cre i�r s dispute� the amouc�c ot'the,job ca�r,
<br /> ih� C�ty t�iay t�qucst t�o etibmiaaio�af x sfgnai Cupy af the aotual Contr$ct,
<br /> '* T'he 5TA�"� SCJRCHAkGE is :(�OQS of cbe cqst.traC� pri�C uadca Si,QqQ,000 or 5.30 - whichcvcr ts
<br /> 8reat�r, �Qf V81U&{IAtI� 04CC SI�OQq,04Q aalI tbe T3epartment oY Inspection�! �ervicc� Par tho pcice-
<br /> Thc undvrsi,�n�$ here�iY appltes to thc Ciry for issuance of a Mcchanicat Perr�it, a$recs to do
<br /> �11 work i� st�ict accordanct with tt� rat�iir�ncc� of thc (:ity arad the rcgul�,cions o�' ti�e Mirulesvta�
<br /> Stat��uiS�ing Cbde, a�d r�rtifcs� that all stat�ments made on this a�p{icatio�n axe c:�rmplcce� tru�e
<br /> �rtc! c�>rfect.
<br /> APAlicant's Signaturt: '�` �_ Date: / ? �$�
<br /> tl�pprov�cl By: ���ilti.�_ D�atc� 1- �Z� f�
<br /> .w.M... . • � --�
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