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Elk,-River BUILDING PERMIT APPLICATION <br />Applicant to complete numbered spaces only. <br /> <br />JOB ADDRESS <br /> <br />2 OWNER MAIL ADDRESS ZIP PHONE <br /> CONTRACTOR ~ MAIL ADDRESS PHONE <br /> <br />ARCHITECT OR DESIGNER <br />ENGINEER <br /> <br />MAIL ADDRESS PHONE <br /> <br />MAIL ADDRESS ' <br /> PHONE <br /> <br />STATE L~CENSE <br /> <br />STATE LICENSE # <br /> <br /> STATE LICENSE # <br />6 USE OF BUILDING <br />7. Class of Work: ~EW ~ ADDITION ~ ALTERATION ~ REPAIR ~ MOVE ~ REMOVE <br />8. Describe Wo~ " /Z ~ <br />9, Valuatio Work: $,~ ~ - ~ <br />Type of ancy Group <br /> <br />Size of Bldg. No. of Stories <br />('Total Sq. Ft. <br /> <br />Use Zone <br /> <br />No. of Dwelling Units <br /> <br />Special Approval~ <br /> <br />ZONING <br />HEALTH DEPT. <br /> <br />FIRE DEPT. <br /> <br />SOIL REPORT <br /> <br />OTHER (Specif~l <br /> <br />ENGINEERING: <br /> <br />ATTORNEY: <br /> <br />APPLICATION <br />ACCEPTED BY <br /> <br />Division <br /> <br /> SPECIAL CONDITIONS <br />Max. Occ. Load <br /> <br /> Fire Sprinklers <br /> Yes [] No <br /> I OFFSTREET PARKING SPACE 3: <br /> Covered Uncovered <br />Required Received <br /> <br />Not Re( <br /> <br /> NOTICE <br /> SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMB- <br /> ING, HEATING, VENTILATING OR AIR CONDITIONING. <br /> <br /> THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC- <br /> TION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR <br /> IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED <br /> FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS <br /> COMMENCED. <br /> <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR/(~ANCEL THE PROVISIONS OF <br />I ANY 0TJ'IER STATE OR LOCAL LAW,REGULATING, CONSTRUCTION ~)R THE PER- <br />I FORM~CE OI~0NSTRUOTION./ './" J /' <br /> <br />I/Signature of Contractor or Authorized Agent/ <br />I--Signature of Owner (If Owner BudderI Date <br /> <br />SAC UNIT CHARGE <br /> <br />ENGINEER FEE: <br /> <br />IPLANS CHE~KEDI APPROVED-'~FOR SURCHARGE: ),~/~, <br /> BY . ' ' A ',(3Y <br /> ~ VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br /> <br />ATTORNEY FEE: <br /> <br />LICENSE CHECK: <br /> <br />pLAN CHECK: <br /> <br />TOTAL: )~/ ~_~',0,~ __ <br /> <br /> <br />