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• ( _ <br /> Detailed description of work: Co r I <br /> V1 ew C: sect e� <br /> Fixtures: (Indicate total number of each) <br /> _Bathtub _Lavatory(R.I) _Swim Pool <br /> Clothes Washer _Lavatory _Tub Shower(RI) <br /> —Dishwasher _RPZ Valve _Urinal <br /> _Drinking Fountain Roof Drains _Vac Breaker • <br /> _Floor Drain Sewage Pump _Water Closet <br /> Flammable Waste Tank —Slop Sink _Water Closet(R.I) <br /> Grease Trap _Shower- _Water Heater <br /> _Kitchen Sink/Disposal _Standpipe/Wash box _Water Meter <br /> Laundry Tray - - - Sump•Pump _Water Softener <br /> Other(describe) <br /> If gas water heater,indicate who will be doing the gas piping: <br /> Address Phone# <br /> State Mechanical Bond# - Please check if on file <br /> • <br /> All Fees are based on valuation, including cost of labor and materials. <br /> The min.imum.fee.is,$45.00+state surcharge. <br /> oo <br /> TOTAL JOB VALUATION: $ I<-/w-- <br /> PERMIT FEE $ (1 V2% of Total Valuation—minimum of$45.00) <br /> SURCHARGE $ (.0005 x Total Job Valuation—minimum $.50) <br /> TOTAL DUE $ 145:5p (make checks payable to: City of Elk River) <br /> THIS IS AN APPLICATION FOR A PERMIT- IT IS NOT VALID UNTIL PROCESSED <br /> ls:lt T'A'I BWfCiI B:E.t IBIltF .ERIGIITt LA I DW ,) 1 7OH9tTHEINFOR11T.ATI(7N'- QV IS <br /> Q1 : T At A cz,ftk* AOru Ekg' I tOgiR i . 10 v .va0 P Nmr.r:.T04: e xT° • <br /> ni.:0 7'A,'ERML'LT ' a -rte, sk y i <br /> I l'JNDERS ND 1re1D HER xR�T �L"k';E3t T TfLD GIR Tkt�E3 RIGf E'1'ER NtLTp LSSTZED7 SHALL= BE <br /> PE&FORME1YACCBItDlN TQ (l)THEI G71*iEYI IONS O LIdF 1?EI�NI P (�a 1 PRIiU ED'PI�4I�IS 1'D <br /> SI'EC7F I(�TLOIVS t' T33F APELI�t1BT.D GLI AE.gi:OnAS,O1tDLiVAl.V`G S"•AND.S8DE5` (4)TI31.� fr <br /> SIATFI BrnLDI'i�IGTPI.TIMBTNd C�DESA EGCI'L.ATIONS �"' ' '� ' g <br /> gzt ''•."^` 5lq. '^ mo t*" 4;tl l,' Z t4tjgr _ s # <br /> I T3NDERSTAND THAT THE'PERIYITTWII L.E.YPIRZ.E.-AND BECOME LTtJ1ILAND VO1D 1S?WORKIS.NO-T <br /> STARTEDWLTHI i 130_DAYS`,f RJIF WORRKI,S Si5SPEI�IDED OR ABrSNL�ONED'FCY t PERIOD OF L30 DAYS <br /> � k <br /> t12V�')i1l�IE':AETr+X�VO:I ZIPF7'AS' Q1VINiEIYGEII,.AI�[D",iTHAT L�IVT'RESPQ:I�fSI$L'E„k'OR•EiVSipm%THATALL. <br /> Q ._.. .._ LMu'�iGE�4vJTI `GHE:$TATE`B�JU]D,LVG CODE <br /> REgUIR'ED INSPE�'III0IVS,ARE RE_I7ESTZ+�LN CQNEQRN <br /> NAME OF APPLICANT S DATE: <br /> •eas .e. ri. t <br />