Laserfiche WebLink
<br /> <br />Site Address: <br /> <br />PERMIT ;; <br /> <br />Q~CjO( <br /> <br />RECE1VED BY <br />DATE, <br /> <br />CITY OF ELK RIVER <br />BUILDING DEPARTMENT <br />13065 ORONO P~-WAY <br />PO BOX 490 <br />ELK RIVER. MN 55330 <br />INSPECTION SCHEDULL~ (763) 441-4900 <br /> <br />Ot::::: Gc\ <br />'l/ILf/u;, <br /> <br />MECH.AL~ICAL PERMIT APPLICATION <br />(; VI M It ,'vI Sf <br /> <br />The Applicant is: <br /> <br />Owner 0 <br /> <br />Suite/Unit <br />Contractor 0 <br /> <br />Other 0 <br /> <br />Property <br />Owner <br /> <br />~ <br /> <br />NAi\1E <br />ADDRESS <br />CITY <br />TELEPHONE <br /> <br />STATE_ ZIP <br /> <br />Contra.ctor <br /> <br />NAME-r;;,mm~ !ctf/.f!:.S <br />ADDRESS 192-7 l..'i'I'1/er Sf- /lW <br />CITY ek;:'lt/~f STATE~ ZIP 5"<>';?$i) <br />TELEPHONE 76:5 .l-<f'j-g ) 7 ~ LICENSE # <br /> <br />Engineer <br /> <br />NAlV1E <br />ADDRESS <br />CITY <br />TELEPHONE <br /> <br />STATE ZIP <br />REG# <br /> <br />USE TYPE <br /> <br />Townhouse n <br />Institutional 0 <br /> <br />Commercialllndustrial K <br />Other (0) 0 <br /> <br />Single Family 0 <br />Multi,Family 0 <br /> <br />New 0 <br /> <br />Alter (AL T)D Repair (REPJO <br /> <br />Other (0)0 <br /> <br />Addi,ion (ADD <br /> <br />PLEASE COMPLETE OTHER SIDE OF APPLICATION <br /> <br />.. SEPARATE PERMITS ARE REQUIRED FOR BUlLDING, ELECTRIC, GAS, OR PLl.iMBING <br /> <br />. _. ---- ----..----.-.-- <br /> <br />..-...__.._---------~ .-.-,,---' <br /> <br />-.-. -.-.-.-.----.-..- <br /> <br />-_._..._--~..._---- <br /> <br />'--'-"-~-'-' <br /> <br />-,,_._-.-._-_..._~._._... - <br />