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Ciro of PERMIT# c <br /> Elk <br /> RECEIVED BY <br /> +v. <br /> DATE: <br /> River CITY OF ELK RIVER <br /> BUILDING DEPARTMENT <br /> 13065 ORONO PARKWAY <br /> PO BOX 490 <br /> • ELK RIVER.MN 55330 <br /> INSPECTION SCHEDULING(763)441-4900 <br /> 4// <br /> MECHANICA PERMIT APPLICATION iLtiO <br /> L. <br /> � <br /> c7'l (,t tY( 5T Suite/Unit <br /> Site Address: <br /> The Applicant is: Owner❑ • Contractor ❑ Other ❑ <br /> Property NAME <br /> Owner ADDRESS <br /> V# . CITY STATE ZIP <br /> TELEPHONE <br /> NAME • a/5 /y //t/t0-6e5 <br /> • Contractor ADDRESS /9 Z7 5 1 h',0/Pf / bi-, <br /> CITY &*- <br /> 4)Vet STATE"/ ZIP "5.5-, 737 <br /> TELEPHONE 76 3 7 LICENSE# <br /> • <br /> • NAME <br /> Engineer ADDRESS <br /> CITY STATE ZIP • <br /> TELEPHONE RE G# <br /> USE TYPE • <br /> Single Family❑ Townhouse r_1 Commercial/Industrial <br /> Multi-Family ❑ Institutional ❑ Other(0) ❑ <br /> INew❑ Addition(ADD' Alter(-4LT)0 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 />