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• <br /> C� I <br /> PERMIT# l <br /> City of <br /> Elk DATE: <br /> 1 1 CITY OF ELK RIVER <br /> RiverTer DEPARTMENT OF BUILDING SAFETY © r 1)(C <br /> l�j�/ j 13065 ORONO PARKWAY <br /> ELK RIVER,MN 53330 <br /> 13065 Orono Parkway '7 )9,(11 Q L-( <br /> Elk River,MN 55330 INSPECTION SCHEDULING(763)635-1060 <br /> FAX(763)635-1090 <br /> PLUMBING PERMIT APPLICATION • <br /> Site Address: 6 5 Yvta.t v. SI--,rt_�-1- Suite/Unit <br /> The Applicant is: Owner❑ Contractor [ Other ❑ <br /> Property NAME£V e+ J 04 I ropco--c- 1--1 <br /> Owner ADDRESS (Q 5 3 ox C., .i-4"- -(- <br /> CITY £ 11( RI Sc-4 STATE AA`^- ZIP S S 3 3 c7 <br /> TELEPHONE `1 `-I 1-c Y/ 1 <br /> NAME P V\) e4`1'ew v -(,d 1 v-'(., <br /> • 1 <br /> Contractor ADDRESS ? O, 3,..))( 3 8 7 <br /> CITY F 11- Rt STATE ZIP S-5-3 3c <br /> T EPHONE d,11-.130 3 LICENSE# 3)- `I PIA_ <br /> f -.. xf‘A' A) <br /> NAME <br /> Engineer ADDRESS <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 (A.DD)❑ Alter(ALT) Repair (REP)E Other (0)0 <br /> 0 PLEASE COMPLETE OTHER SIDE OF APPLICATION <br /> SEPAIA TE rDI M1 T S ARE REQUIRED FOR BUILDING, ELECTRIC, OR HVAC WORK <br /> • <br /> www.ci.elk-rivernin.us <br />