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<br />D",~ed description of work: (! vi J I'"j ~ <br />QVl& ~re..t-.. c.ir -\--<-.:> <br /> <br />) 50 o~t 11'1&';" .klt:;;- <br />t=='...., ~ <br /> <br />Please check all boxes that apply! <br />OAlC <br />~Air to Air exchanger <br />o Dryer Venting <br />tI Duct work ((love OY\€ <br />o -F urnace <br /> <br />o Boiler <br />,KJ COII?-bustion Air <br />o P901 Heater <br />D Refrigeration <br />o Solar <br /> <br />Fill in the appropriate boxes below: <br /> <br />o Class I Hood <br />o Class II Hood <br />o Heat Pump Appliance <br />o Overhead Radian Heaters <br />o Unit Heater <br />o Other <br /> <br />Make Model # Heat Fuel Flue Input CFM Tons Hp <br /> Loss/Gain Diame ter (BTU) <br /> . <br /> <br />All Fees are based on valuation, including cost of labor and materials. <br />The minimum fee is $45.00 + s~ate surcharge. <br /> <br />TOTAL JOB VALUATION: $ <br /> <br />500 00 <br /> <br />PERMI' FEE $ t.t5.0u (1 y,% of Total Job Valuation - minimum of$45.00) <br />SURCH..-'\RGE $ .5D (.0005 " Total Job Valuation - minimum $.50) <br />TOTAL DUE $ 46.sD (make check. payable to: City of Elk River) <br /> <br />HIS IS At'" APPLICATION FOR A PERMIT. IT IS NOT VALID UNTIL PROCESSE <br /> <br /> <br />NAME OF APPLICA.c'iT J "lvVl ~:t",,};;':'~! (c.. S <br />SIGNATURE OF APPLlCAt'iT ~'~?V.-c- <br />( .-.,/ <br /> <br />DATE: <br /> <br />-..-.--.--..--..---.---------.- ... <br /> <br />.- ---.-....-.-...- <br /> <br />___._.n____u. <br /> <br />.... ---.. -.. .--.- --.....".- <br /> <br />..---,.--..-.-'-'- <br /> <br />.._..~..~.._-_..-..__.. ..---.. <br /> <br />".-..--.. -..------ -...-...----. <br />