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DATE , 1e„? /� ,O Y
<br /> ...,,/,
<br /> •
<br /> PERMIT # a 01-A_Cc.)
<br /> CITY OF ELK RIVER
<br /> BUILDING PERMIT APPLICATION OFFICE USE ONLY
<br /> JOB ADDRESS f 5. in in sip ee - ENGINEER FEE
<br /> THE APPLICANT IS: ❑ OWNER cz ONTRACTOR/OTHER(DESCRIBE) PERIVIIT
<br /> 4.easee
<br /> LEGAL DESCRIPTION SURCHARGE
<br /> SUBDIVISION LOT BLOCK PID#
<br /> SEWER
<br /> Pau/,neon /42 6-/dJyys 44 Ss;vs- 6i x33
<br /> PROPERTY OWNER NAME ADIII2ESS PHONE# ATTORNEY FEE
<br /> C3-'-1`11- ono\
<br /> CONTRACTOR LICENSE# LICENSE CHECK
<br /> NAME ADDRESS PHONE
<br /> //1 C • ., imif #cl L • l4 . _ PLAN CHECK
<br /> ARCHITECT/DESIG '11 R/ENGINEER • •i
<br /> NAME ADDRESS PHONE# TOTAL
<br /> 11.61 .0 \
<br /> CLASS OF WORK: ❑NEW []ADDITION ❑REPAIR fx RE MODEL ❑ DEMO APPL RECD BY
<br /> • DESCRIBE WORK (i14.4- b el-elate-4-1 , /� sDE'cel.- L
<br /> aise, APPROVED FOR
<br /> /2 e 4 a-0114 4-'• ISSUANCE BY
<br /> VALUATION OF WORK: $ 5(-c-O, 0-0 TYPE OF
<br /> • CONS, TttTION
<br /> COMPLETION DATE - -, DO
<br /> ENERGY CODE USED FOR THIS PROJECT(RESIDENTIAL CONSTRUCTION) OCCUPANCY
<br /> ENERGY CODE OPTIONS: 0 CATEGORY 1 ❑ 2000.ENERGY CODE GROF\
<br /> SEPARATE PERMITS ¢RE;REQUIRED FOR ELECTRICAL,PL i1MBING HEATING, = , : DIVISION
<br /> VENTIL4riNGOR RCONDITIONING' � ,4 ,� .,s {
<br /> TEAS PERMIT BECOMES NULL AND VOID WORS>OR CONSTRUCTION"AUTHORIZED IS SIZE OF BLDG
<br /> NOT COMMENCED WITHIN 180,DAYS, OR IF CONSTRUCITONOR WORRISSUSPENDED (TOTAL SQ FT)
<br /> OR ABANDONED FORA PERIOD OF180 DAYS ATANY TIME AFTER WORK 1,$,,,:; .::.;,,,i:-.„,;::: ,,,,:::::. .
<br /> COMMENCED fi c 6,, . ,v
<br /> y :. 't.�.�r� , ..� ,. ' t s l uz i g - r k A x :, ? ' #OF STORIES
<br /> 4. HEREBY,C'ERTIFY BRAT LEAVE READ EXAMINEATHIS`APPLICATIONAND SNOW>
<br /> THE::SAME TO BE"TRUE'AND CORRECT=ALL`PRO VISIONSOF Frill AND ORDINANES•GOVERNING THIS.TYPE.OF WORK WILL BE COMPLIED WITH WHIETHER SPECIFIED MAX OCC LOAD
<br /> HEREIN OR NOT"THE'GRANZII VG OF A PERMIT DOES Nor PRESUME TO>GIYE
<br /> A'UTHORIT I'TO VIOLATE OR.CANCEL'THE.PROVISIONS OF ANY OTHER'STTATE OR :•::::::::,.(..'
<br /> LOCAL L RESU HATING CONSTRUCTION OR THE PERFORMA11 CE OF CONSTRUCTION-. USE ZONE-:i..,:...;.-7,/, ::::,,i,1--,,:.. ,:.:.,.-.:: :::,,,..,: 3,:.,,;t::::„.,.L::,,:i.3.,..,,,,,.:.,:,.,,,,,,.,.,.::::.„.:::.•-•:i-','i.:7-‘,,- -,• -,•,,-'-,- - .• \
<br /> SI! • 'TURE OF CONTRACTOR DATE ,. `� FIRE
<br /> ,\ `SPRINKLERS
<br /> 0 dor , . , . REQUIRED
<br /> ❑ YES
<br /> SIGNATURE OF OWNER DATE ❑ NO
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<br /> BUILDING DEPARTMENT•PHONE(763)635-1060 •FAX(763) 635-1090
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