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r •J.�n-04-YDO1 03:06pm From-CITY OF DRONQ +6dtZqg4$16 T-16g P.008/008 F-Z�� <br /> � ' M <br /> YRF LA�G t , , . <br /> � ras fact�,�y flrEplace � <br /> �, '9V'ood bur� factory i'irepl�te vvith flue . <br /> �,� Wood Stove <br /> _,., Wood stove with tlue . , <br /> ' Brand Name ARiode]I�1'o. � . <br /> . . ... .-.,�.�..�_.. ..... . —.. .. _ <br /> � • , - � . ' • . � , . � <br /> V�NTn.A�Q�v � � _ � , � � � . � ' . . <br /> . . I�T�. '� � ��Kirchen�xba.ust ductcd � recircula�' � efi�a <br /> . . � �No. � � • $�th ExhaxlsC '(u�.0� ductad�utside) ' ' cfm <br /> � N'o, ____^ ' OtYier Faris: LocaCians " . ' � � .. efm <br /> ..--�. ..� . <br /> �:�r.FL sTOR�a►.rt�':• (�7sT��APPR4VEb�Y F�RE M.AYiSYYAY..) ' . . <br /> � Ynscallati�n � • Removal • . . <br /> � •, . .. <br /> ,,,� Pu�l oil: _____ gallQ�. �• undergraund' �;,.,_ insid� �'outsad� <br /> ..._,_„ ],.1'4�s: .� galloas <br /> ;�Other ' . . . . . . . .�o�� <br /> .-.�....... ... _, :...�._ r..,�, . <br /> �'L�`RMr'Y'F'E+' CE��"a,�s 'lZQN � � • <br /> 1, �,�5°lo of C4ntr���'rice� or 4 � <br /> � , • • x .Q125 $ ' . . <br /> • • ---------�•- <br /> ) <br /> 2. , �"t�t� Surcbarg�_ �`* Add Che State Buildin� Cade l�ivlsion � � , <br /> Suichaxge to each permit, x .OU05 . $ .�� <br /> � �r,�.Sp,�wluchever fs gc�ater , tconcrar.t pr�ce) . . •• <br /> , .. . , . <br /> 3. Po�ig�*,,�anc��Ian�.lin� (Clnay mail-in appliCations) , , ,, $ � �_�, 1.50_— <br /> 4. 1'{JTALPER.MYT 1�F (Add lines 1-3 at�Ave) $ ����� <br /> W CaNTTtACT PRICE or JpR CdST meatis tbe aalual or estL�taced�altar aawuat cbargad far the permitt� <br /> wark iach��8��cerialg,t�bor.preflc.aud other fix�d ca�ts. IC is t}�amo�iut to be c�aZg�to i1'+e eustomc� <br /> f�r the work done. If any materi�l,�eguipment,lahur,Qr iw+t�.11atton aze fi�ished by rl�e ownr�,tenauc og <br /> .any d�h�r pariy rrie ceaso�abla markec v�lae of such ite;ms mu�be added to tbe esqwa�ed oost or con�.ra+�� <br /> prieo,fot�tmit too gurposes, ln ihe eVCAt tb4[thare i6�diSputa oa the ttruount of the juh cost��he Ci1y m�y <br /> �requesc c�e su�mFFssioa of a�igaed Gppy ol'�e ao�ual con�rae�. . . <br /> ��' '1'he STATE�URCKARG�is�4045 8f the cancract prlo�un�ler$],OQO.OQO ar �.50-wluch�ver is�reae��� <br /> � For valuaticros over$i�000.000 0�11 thg lyepatttnen�oF Lo�pe�ianal Servic'r�s for the price. <br /> The unders��,ned her�by flpplres ta the(:ity fpr�Qsuance t�f a MechA���P on�s of thre Mi�it����� <br /> work is �crict acaordance��l s tbat al�te�nt�s niade o this �pp�tic►a ar� coa�p]ei'e, fi�e , <br /> st�te Duilding Code� a�d - <br /> �ut1 �orrect, , <br /> .r�"_ . <br /> re <br /> � � � ' � ,� .-� Date: �.=:�` �� <br /> AppliGanti''s Si�natu +� ..�'.��r . <br /> f <br /> ' Date: � <br /> Appro�ved 8y: �___�_.- .`.-� —_... I <br />