|
Derpiled description of work: t` ! d .4.a--, �O C'r} ��r'G� 61
<br /> Q vt a f.f Es'�•\ G ; f o S »�
<br /> Please check all boxes that apply
<br /> ❑ 4/C ❑ Boiler ❑ Class 1 Hood
<br /> Air to Air exchanger K Combustion Air ❑ Class II Hood
<br /> ❑Dryer Venting ❑ Pool Heater ❑Heat Pump Appliance
<br /> Xj Duct work('/10✓e On€ ❑ Refrigeration ❑ Overhead Radian Heaters
<br /> ❑Furnace ❑ Solar up
<br /> Unit Heater
<br /> ❑ Other
<br /> Fill in the appropriate boxes below:
<br /> Make Model# Heat Fuel Flue Input CFM Tons Hp
<br /> Loss/Gain Diameter (BTU)
<br /> 1
<br /> •
<br /> All Fees are based on valuation, including cost of labor and materials.
<br /> The minimum fee is $45.00+state surcharge. 0J
<br /> TOTAL JOB VALUATION: $ 500'
<br /> PERMIT FEE $ �-5.0U (1 Y2% of Total Job Valuation -minimum of$45.00)
<br /> c. "
<br /> SURCHARGE $ •0 minim—
<br /> `" (.0005 x Total Job Valuation- um $.50)
<br /> TOTAL DUE $ - X6''5 (make checks payable to: City of Elk River)
<br /> THIS IS AN APPLICATION FOR A PERMIT- IT IS NOT VALID UNTIL PROCESSED
<br /> .ate- `r-d. oa'7�� .vF" „as sam9 ate+, a . ,
<br /> < a a° wwa ''.n.• u a �Er% to nniaa Y f r",*:,,e ., x..... .' �•i °1, t r aa'~ -9't - '''' ' "4-t. -li tiii, ret° .,-*1.-:-,L-4.,r +� y:
<br /> `-'�,2- �."' •44-• . xK x . ' 9 ffil-4 - A t 4 °�" x `y a ,r a 7:,,,=.i:=.
<br /> ' »ug, .yl++ n ay.sa 3 v 7� a c. d sa a s .`a'e4_iE. 3`)a"�" n u 75'.v.,, e1
<br /> IL TIT- C fifjCFPi EdI� ...SAQEIS,,„ k'' nip - 3a;+' S -re E CM°r W
<br /> gp i C"9: 5��'a�.trr agnflPy'P'!'t6}+��B:S as „it' psi aaF n^""s.aa„$. d -70-,-, .t.-f:,-
<br /> -�-.n m-- - -' t r , a' b �.-rfi rani -m;
<br /> `.42161--e y ' - �73RE lgl fre ;..-� r+�\
<br /> r^"D“6"" � !S Ik �kNPi �` "'�eP '�y1ryp y a .,1�+`�s°'°d av$ ¢M;.y� LY AYS ?�.. s. i'8,.a-�' $�' t�-hf ,.
<br /> -;'t Efts L' ,TIMPESt^VII�'y. n t.ii TIt ''''3' t"--”lEkiVLrE.,,,G:Pr3!&9rD.,j:, :-' ?,g "a "
<br /> Ad d.n ' 31'1"3a,Dt1'E-,44,RIEa�. egEF. SL[7E,Fu B.-Er ,TR' S titGe`i73 ' e fl
<br /> Sfn'ii.ial. mpUlis2tk Iic '4 i '•FG,F.�F7'91'WDr itltr.tac 1 EPP,O--,-, ,`+ a s ' re a :s-
<br /> I1.EratirSL',£CTI.C/N.-8 C.K.$42LE FtDl 2'VIA"Ie.DsW`L+TFI'--EA'I';f�,. b i' a a ..�;"
<br /> NAiv1G OF APPLICANT
<br /> C7V%I Yr.y' I/(,'•i-�t S DATE: 7 /� /c-�
<br /> Please or print
<br /> SIGNATURE OF APPLICANT i'
<br /> /--
<br /> �j �
<br />
|