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SMIP _ 0 DATE � � APPLICANI: . _. _ . . . � WAM�IN@FA ETOSECUREW�RKER4COMFENS�TIONOOVFRAOEIS DSHILLLBE ENERGYPlC $(Ifl1ECTIWEMPLOYER70CfiIMMKPENALTESIWDCMLFNESUPTOOh Reonausuro ENERGYPERMIT� � - ' ppLLARS(fta0,D00�,MlADD�TWNTOTHECOSTOFCOMPENSIITqN,D�1AAGE3/3VFIOVI�mFOHn'1 J SECTbNf7oeOfT�EUNOncooEMERESCMA�T70RNEY'SFEES. RETENTIONFEE: - ' . . . . ____ . _. .. . . � CONSTRUCTION LENDINti AGENCY PHE-ALT FEE: � I HEHEBY AFFlidA UNDER PENhLiY OF PERIJti'(TUT iHERE IS A�UNYTRUCTION LENDRq AOENCY . • - . . Z FOR TNE PERFORAIPIICE OF TNE N'ORK FOH MM�b/7MiS DERMIT IS ISSUEO(SEG]oY7.cN.CG , W . � IENDEA'SNM�E . - � LENDER'SMDRE53 � ICffif�F'1MATIHMEAEADTtl4APPLiCATIONfND3iAiETUTTHE/�B0'JEINFON.UTpNI3CONREM. TOTAL FEES . ; • a i uar�e ro ca.�n�rwm�ul«n um caartv oannu�cEs u+o sr�re uws nEunrw 10 euw�no � CONSTiR1CTqN.ANOMEREHYAUT110RREHFPRESEMATNFSOFT/95COVHfYTOENTERUPONiME __ ._ _ . . . . SL? /�gpYE-MEMqHm PROVERTl FOR MSiECT10N PURPOSES. 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