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<br /> Detailed description of worlc: — e 6 . 4,i-ii 9 I50 c/ei Ilepti-- 732,11
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<br /> C) di cFrest-\ t i r 1 ,...;-, C.--
<br /> Please check all boxes that apply!
<br /> 0
<br /> A/C .
<br /> 0 Boiler _—__ Class 1 Hood
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<br /> 0 it to Air exchanger , E Combustion Air Class II Hood
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<br /> 0 Dryer Venting • 0 Pool Heater 0 Heat Pump Appliance
<br /> Xj Duct work eaoVe Olk'E. 0 Refrigeration 0 Overhead Radian Heaters
<br /> 0 Furnace 0 Solar :— Unit Heater
<br /> 0 Other
<br /> Fill in the appropriate boxes below: .
<br /> _ -
<br /> Make Model# Heat Fuel • Flue Input CFM Tons Hp .
<br /> Loss/Gain Diameter (BTU)
<br /> III . . .
<br /> All Fees are based on valuation,including cost of labor and materials.
<br /> The minimum fee is $45.00÷state surcharge.
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<br /> - TOTAL JOB VALUATION: $ ,..)(-1U.
<br /> PERMIT FEE $ 403 (1 A%
<br /> ' of Total Job Valuation–minimum- of$45.00)
<br /> SURCHARGE $ r-:-.) ,•,,
<br /> - .) Li (.0005 x Total Job Valuation–minimum $.50)
<br /> TOTAL DUE $ (make checks payable to: City of Elk River)
<br /> THIS IS AN APPLICATION FOR A PERMIT- IT IS NOT VALID UNTIL PROCESSED
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<br /> NAME OF APPLICANT / III /i/ r -
<br /> 6'?V rnv t G. R._ S DATE: q.//576 3
<br /> Please type or prr:nt .
<br /> • . , ...,
<br /> SIGNATURE OF APPLICANT
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