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City of y PERMIT <br /> Elk �\ RECEIVED BY <br /> V <br /> 7e DATE: <br /> CITY OF ELK RIVER <br /> BUILDING DEPARTMENT <br /> 13065 ORONO PARKWAY <br /> PO BOY 490 <br /> ELK RIVER,IvLN 55330 <br /> INSPECTION SCHEDULING(763)441-4900 <br /> MECHANICAL PERMIT APPLICATION <br /> // <br /> Site Address: � (- / 64- SuitefUnit <br /> The Applicant is: Owner❑ Contractor ❑ Other ❑ <br /> Property NAME <br /> Owner ADDRESS <br /> CITY STATE ZIP <br /> TELEPHONE <br /> 410 NAME /, d7 lr��/ �,�— <br /> • <br /> Contractor ADDRESS / 9 2-7 5 Z�'°"��`�r 7L /1/14-6,CITY <br /> eJ --„ei /ei/ STATE NV ZIP 5'S": <br /> TELEPHONE 76 'V/-`5 7 LICENSE <br /> • NAME, <br /> Engineer ADDRESS <br /> • <br /> CITY STATE ZIP <br /> TELEPHONE REG# <br /> ( USE TYPE <br /> Single Family❑ Townhouse ❑ Commercial/Industrial <br /> Multi-Family ❑ Institutional ❑ Other (0) ❑ <br /> New ❑ Addition(ADD Alter (ALT)E Repair(REP)0 Other (0)0 <br /> PLEASE COMPLETE OTHER SIDE OF APPLICATION <br /> ** SEPARATE PERMITS ARE REQUIRED FOR BUILDING, ELECTRIC, GAS, OR PLUMBING <br />