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07/22/2004 13:59 6125291064 <br /> I.b.7L .1,* BARNES PLBG <br /> .• <br /> i . PAGE 01 <br /> Aec C(...--erp—Fc2--e <br /> PERMIT# ; <br /> . : 1 <br /> Eci'f if k • affskr-, <br /> Illalto..r.... • <br /> CITY OF ELK RIVER DATE; ! ---1/2-0.--/: =-I <br /> ; / , <br /> River DEP.42.ThrENT OF BUILDING SAFETY <br /> 1306s O.RONO PARKWAY el• <br /> ELK RIVER,MN 5'53;30 . 0 - (>°\ <br /> 13065 Orono Porkway <br /> Elk River,MN 55330 INSPECTION SCHEDULLNG(763)635-166o <br /> FAx(763)6:35-1090 • Sk610't <br /> PLUMBING PERMIT APPLICATION! r 42 <br /> • .6 b <br /> Site Address: _ 65/ VP/Ai s*. N tAl Suite/Unit I <br /> The Applicant is: Owner E Contractor .0 011.-.„., E <br /> . : <br /> ...,. . <br /> Property NAME ti.,„:,...,.,,, <br /> . . <br /> Owner ADDRESS r:'4:1.:5*.1.4' `....!:7774-4 ' • . <br /> . • <br /> • CITY 1.11.47•••!4 STATE-c•nfl 0 , ZIP <br /> . . <br /> . 1 TELEPHONE i'. -'• - 7,--.1 i-. <br /> ■ • .• <br /> . . <br /> . 1 •• <br /> . . • <br /> • <br /> -. - './- - /.7 <br /> NAME___.• „,..2../Q ,i'",.L.:.) 1 ; -e---#111../0/t.,..,,, ,' ,....? ,,, <br /> • Contractor ADDRESS :.. / ;4.-' ' •Ai; • <br /> CITY ' fr:',,41..!....--; 'STATE )• i - ZIP s4.:*-:'Z.:.•'15.:7::,•;"?... <br /> TELEPHONE I.1.7a," ,71---::'•::.,: S1-.- ff 71 ...',.‘_ LICENSE ..,,,..7.7,e <br /> , . . <br /> r • NAME . <br /> . ' <br /> • <br /> • Engineer ADDRESS • • <br /> ; <br /> I CITY STATE ZIP <br /> TELEPHONE REG# <br /> . . <br /> • USE TYPE . ! <br /> .Single Family 0 Townhouse 0 C-orrygler,.4a1/Inciustri4 2 <br /> Multi-Family 0 Institutional 0 Other (0) i Li <br /> 1 , <br /> • ' <br /> . : <br /> LI <br /> T.ew 0 . Addition (ADD)0 Alter (..A1ThlRepair (REP)C] Other (0)C] i <br /> • PLEASE COMPLETE OTHER SIDE OF APPLICATIO'N <br /> :--IEFAPATT: rillf.,7.41TS ARE REQUIRED FOR BUILDING, ELEcTR1C,101i.I-ivAC WORK <br /> wwwxi.elk-river.rnn.us 1 . <br /> • . . <br /> ' • <br />