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• <br /> C),e_. a ' i. Q-1 <br /> Detailed description of work: <br /> Please check all boxes that apply! • <br /> ❑A/C ❑Class II Hood Q Fire [a ce <br /> ❑ <br /> Radiant Heater <br /> ❑Boiler ❑Combustion Air ❑Furnace ®. Refrigeration <br /> ❑Air to Air exchanger ❑Dryer Venting ❑ Heat Pump Appliance ❑ Solar. <br /> ❑Class 1 Hood ❑Duct work ❑ Pool Heater ❑Unit Heater <br /> ❑ Other • <br /> Fill in the appropriate boxes below: <br /> Make Model# Heat Fuel Flue Input CFM Tons Hp <br /> • Loss./Gain Diameter (BTU) <br /> i . <br /> . 1 <br /> Gas piping• . <br /> Please check all boxes that apply! <br /> • ❑ Eviler <br /> 0 Fireplace ❑Gas Main ❑ Unit Heater <br /> 0 Dryer ❑Furnace ❑ Range ❑ Other <br /> - <br /> If gas piping will be done by others indicate: Name <br /> Address Phone <br /> Which appliances <br /> State Mechanical Bond# n Please check if on file . <br /> All Fees are based on valuation,including cost of labor and materials. f / Q/I1 � <br /> The minimum fee is$45.00+state surcharge.TOTAL JOE VALUATION:$ ! /2 C� , <br /> PERMIT FEE $(4s=-1_, C) " (1 `4%of Total Job Valuation-minimum of$45.00) <br /> • <br /> SURCHARGE $ :71 ((C.' (.0005 x Total Job Valuation-minimum.$.50) . <br /> TOTAL DUE $. -0 • y 5 (make checks payable to:City of Elk River) <br /> THIS IS AN APPLICATION FOR A PERMIT-IT IS NOT VA r.m UNTIL PROCESSED! <br /> i i EB i74. .M 3 F�•rA 11.WA 5 4 - E?U F14 a BS"+'6 E:1fi T"^ 48 041"i <br /> . <br /> i;t70, EtET . 1)1G 1,1, '0 t f: .I 3 s . 042 411, 4 v F <br /> S. AR LS0.1 'ERLZ ? U• V1r. ' * " 41 * a'ae <br /> x ' v tl DJzst X40.4# a �� , F �r IR .Pg rl n E <br /> EEEE'O.F"u1ED.AC-,aC,gbii§l 4T4a fff Ctr1611ti:gI iftbi tl'HalijZ.MaT� =? Q DdP .IN:U tr <br /> EGISTYCA�"TTpm' -rgi 'g,70 R liACeSEgE Et.'ids2�•PEl2Q ;flAaRli 61K S•.P.a� itiarPESvA�FI4t4.)� -'�-- <br /> SBkTZ;.BT5171MTw - i`41 .6L 10�E.4•- 1iltE .[ i3.rI`LO .! •V g`tat".s-4:1V-40471 1 <br /> ,, ( , ;;,�IF,.„�;.*•`at ,cw, S# �e .�,�" �' F' ,,,, a x.� cs Sr, ( .`k` s•' �"' .vyr•>�tPDat. ,s a n I Et�I�1�< r.�. z �a�;sir 'cA A ytgEcpi?ydz.T rs Tp <br /> 9') t2TTT7ikUIltA?t.i bgatir S' © ,4 ' flrtISSLSJ''E�ID DSOR.ABA&-DONzI1rEf �PL'i3:.IQD Or 1a0 DAYS <br /> . A1NTIvr. A •l ;:111 LlBltl•Gcr.RmI3 CONC1LENCED 4J D.TITAi:ICAaIT`rESFaNGIEZMEORIONSLRTI G"1 T-LAT ALL a-- <br /> R13.Q,UIRED bLV SPE CT1 O i`IS=£�R] Q EST.ED I.�\i,�'Gzi�r7() `l C.Z-.1.L 'fi T43 T E.B LTILD L'N G;C•ODE <br /> NAME OF APPLICANT- -'�.JjC 4. DATE: <br /> Please Type or print ( n 1 <br /> .¢ir_NATTTRF(lE_��-- , 0l /. ' __. <br />