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<br />DATE ,k ~ . 1; dOO r-/
<br />PERMIT # 0-.\01..\..(,"
<br />
<br />CITY OF ELK RIVER
<br />BUILDING PERMIT APPLICATION
<br />JOB ADDRESS iPS I rYlain sheeT
<br />
<br />OFFICE USE ONL y
<br />
<br />ENGINEER FEE
<br />
<br />THE APPLICANT IS:
<br />
<br />OWNER
<br />
<br />ONTRACTORJOTHER (DESCRIBE)
<br />
<br />PERlVIlT
<br />
<br />SUBDIVISION
<br />
<br />LEGAL DESCRIPTION
<br />LOT
<br />
<br />SURCHARGE
<br />
<br />BLOCK
<br />
<br />PID#
<br />
<br />PROPERTY OWNER
<br />
<br />
<br />SEWER
<br />
<br />
<br />
<br />
<br />ATTORNEY FEE
<br />
<br />CONTRACTOR
<br />NAME
<br />
<br />LICENSE #
<br />
<br />PHONE #
<br />I ~3- - a""\~\
<br />
<br />PHONE~~ ~;:,OJf
<br />
<br />LICENSE CHECK
<br />
<br />ADDRESS
<br />
<br />
<br />r
<br />ARCillTECTIDESIG
<br />NAME
<br />
<br />PLAl'l CHECK
<br />
<br />PHONE #
<br />
<br />TOTAL
<br />
<br />CLASS OF WORK:
<br />
<br />
<br />ADDITION
<br />
<br />
<br />REMODEL
<br />
<br />DEMO
<br />
<br />\l~1 ,~~
<br />APPL RECD BY
<br />
<br />DESCRIBE WORK .
<br />~-#-
<br />
<br />VALUATION OF WORK: S ~0 &-0-0, c-o
<br />
<br />COMPLETION DATE - C><>
<br />ENERGY CODE USED FOR TillS PROJECT (RESIDENTIAL CONSTRUCTION)
<br />ENERGY CODE OPTIONS: 0 CATEGORY I 0 2000.ENERGY CODE
<br />
<br />
<br />APPROVED FOR
<br />ISSUANCE BY
<br />
<br />
<br />ION
<br />
<br />OCCUPANCY
<br />GRO
<br />
<br />SEP'ARATE !,lPW.!!S.~REQJJIRED f.C?J,!pECTRI
<br />VENTIUXING;O ,. . ',""'.
<br />~,~~.r~~~~::r.~~~
<br />E#'tr;-~~~'~
<br />TillSPERMlXB SNUL. VOI1>lFWO '. ,ONSTRUCTlO,. ORlZEDIS'.;
<br />NOT COMMENCEintITillN ~8ir DAYS;'oIi IFCONSriwcITIil'i OR WOIiKIS SUSPENDED"
<br />~~;t;lco;wFORAPERlODO 180'Ifw:YSATANyT' :;fJ~~lrOR1HS':;j~'~tL},:
<br />
<br />".,",.1j,>~~,. ".,..' ..,.', ""',.:u,""""
<br />'~.i<~)!(<_~~:~{~-A~ '" _ _ _ _ _ " _". _ta::'0,:;:~':J"_->->'T'~';!~;:,ri~:';"0):
<br />i1iiiREiiYCEKit TiHAVEREAD:EXA:M1N. THISA1?PLl lON;.d{JiKNOW
<br />THE,SAME TO BkTiWEANlJ,CORREcT,:';af..:iRoVisIONS oJ: i.;4fvs.AND ORDINANES ,,"'
<br />iioviJiN.iNG THIS TYPE OF WQRE:WlLL BE COMPLIED wllH WHETHERSPEG:IFIED
<br />HEREiN OR NOT; :THE. GRANTING Of' A.PERMI1! DOE,S NOT PRESUME-TO, GiVE:i,~ . '.
<br />A![JTHORiTY TO vrllEATE OR, cAfrCEL: 'rHE PRovisIONS: OFANY.OfHER:S:r54TE OR" ..
<br />LOCAL .. 'RESU . TING CONSTRUCTI()N OR THE PERFORMANCE OF CONSTRUCTIOM
<br />""":. ' '. - '. ~ n . -,~, 'C ......,-.. ,:'_:':,,' ", "'
<br />.;;;:,/,~;rl.\:-;~;':,~..iA-,. - ",-,."".
<br />
<br />
<br />",5;,
<br />"",;;':~'"
<br />
<br />..
<br />
<br />DIVISION
<br />
<br />L
<br />
<br />SIZE OF BLDG
<br />(TOTAL SQ FI)
<br />
<br /># OF STORIES
<br />
<br />MAX OCC LOAD
<br />
<br />USE ZONE
<br />
<br />
<br />
<br />DATE
<br />
<br />
<br />DATE
<br />
<br />FIRE
<br />PRlNKLERS
<br />REQUIRED
<br />DYES
<br />o NO
<br />
<br />BUILDING DEPARTIvIENT. PHONE (763)635-1060. FAX (763) 635-1090
<br />
<br />.._..~..._-.- -- ----. --...-.-.--.--....
<br />
<br />_...._..~.,-.
<br />
<br />--.---"
<br />
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