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• <br /> •Detailed description of work: <br /> 0 atik i, 9 I 5-0 net feit)— 17 5 <br /> CI Vl& CFI('Est-. G i r 4"-= ' -'..- <br /> Please check all boxes that apply! <br /> ❑A/C • ❑ Boiler ❑ Class 1 Hood <br /> )Air to Air exchanger , K Combustion Air ❑ Class II Hood <br /> ❑Dryer Venting ❑ Pool Heater ❑Heat Pump Appliance <br /> XI Duct work(Nye on-E. ❑ Refrigeration ❑ Overhead Radian Heaters <br /> ❑Furnace ❑ Solar ❑ Unit Heater <br /> • ❑ Other <br /> • <br /> Fill in the appropriate boxes below: . <br /> Make Model# Heat Fuel • Flue Iapuit CFMYI Tons Hp , <br /> Loss/Gain Diameter (BTU) <br /> • <br /> • di <br /> All Fees are based on valuation,including cost of labor and materials. <br /> The minimum fee is$45.00+state surcharge. . <br /> TOTAL JOB VALUATION: $ 500" <br /> PERMIT FEE $ 461.0P3 - <br /> (1 44%of Total Job Valuation—minimum of$45.00) <br /> SURCHARGE $ (.0005 a Total Job Valuation—minimum $.50) <br /> TOTAL DUE $ 145-' (make checks payable to: City of Elk River) <br /> THIS IS AN APPLICATION FOR A PERMIT-IT IS NOT VALID UNTIL PROCESSED <br /> gam ,gs ai' ` i-c . <br /> e-ma •^ �1.e�C► 1,z31 iA "XP T"cw' ma &an�vl :iq a s -�� �1 .1:11.1, 1- <br /> � fits N A 3 p <br /> P 3¢'11 ! kWZAQ'1H' w'. 1. ..rc -,41 ' ,� ' i. '.r+ 1 ° .^r..r _ pL <br /> '_p„3.o a t a3-e '-rf x�+a` e;k -", „4 a Pk'' ' Yxw,lz.-. r, 2 '#p t, r ..�, w 5a 4 <br /> Zl `�LE��:'1f5 � �rt "'�`,17_i4',", e � � � i E h,��'�°�. u�� �ra..sa$3 <br /> +u r s+.r a. "'k "' ? 3�-n3 "r(H1 14 'r•1 9'9q :- <br /> ac: • ,F1Il4 rr r 1�1 N'a �u 6% a 3,4 1,4 '-01 <br /> .�J?,�r�t��, LaL4 Mfr .�� � '�. . }j { <br /> T2 .Btr' D]<RC RGR. C itifi -0.*EGgI Tai A' - >< ,i`* a. <br /> Yt , s}". 5'4 R' ,*P53`� -:f4a"S • .x,fi£ .-q — ,r^d rh-'.s &e K-''+t` ,- . .^'. <br /> lucs�xr.. 4 <br /> I.PI kDDR� LAri'i' .ER. dA hit MOP U �.. 411I;" » f lyt;4 1 V,Cr 4 ,..‘k....-t. :7.4:, <br /> 7,•* iT)*771V.aP TJ Q-*.T. B 4B II,,,,,1R: – „u . p 19tSE : <br /> 0 ry 1 14: <br /> .tztirt -bl5Wktlia�v Tr W cure a iii > ... <br /> NAIVE OF APPLICANT J v0 nti y� ��r IL S DATE: �"�//Ti c_..) <br /> WP!edse type or prat <br /> SIGNATURE OF APPLICANT • <br /> � <br />