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<br />,. . <br /> <br />Detailed descnptlOn of work c..o n i\-e.c.. ~ e. of 1~~'''':'''1 p'1 v 1M. !4 I '^-~ k <br />\f\ e v.:> e ~ S€u:J v.. <br />, <br /> <br />Fixtures: (Ind1cate total number of each) <br /> <br />Bathtub <br /> <br />_ Clothes Washer <br />DIshwasher <br />_ Drinking Fountain <br />_ Floor Drain <br />_ Flanupable Waste Tank <br />_ Grease Trap <br />_ Kitchdn SinklDisposal <br />_ Laundry Tray <br />_ Other (describe) <br /> <br />_ Lavatory (R.I) <br /> <br />SWIm Pool <br />_ Tub Shower (R.I) <br />Urinal <br />Vac Breaker <br />Water Closet <br />_ Water Closet (R.I) <br />_ Water Heater <br />Water Meter <br /> <br />_ Lavatory <br />RPZ Valve <br />Roof Drains <br />~ Sewage Pump <br />_ Sl~p Sink <br />~ Shower' <br />_ StandpipefW ash box <br />_Sump Pump <br /> <br />Water Softener <br /> <br />If gas water heater, indicate who will be doing the gas piping: <br /> <br />Address <br />Sta.te Mechanical Bond # <br /> <br />Phone # <br />o Please check if on file <br /> <br />All Fees are based onvaluation, including cost of labor and materials. <br />The minimum..fee; is,~45..:00 + state surcharge. <br /> <br />TOTAL JOB vALUATION: $ I <joO~ <br /> <br />PERMIT FEE $ ~iO (1 '/,% of Total Valuation - minimum of $45.00) <br />SURCHARGE $ (.0005 x Total Job Valuation - minimum $.50) <br />TOTAL DUE $ ~6".5D (make checks payable to: City of Elk River) <br /> <br />rrHIS IS AN APPLICATION FORA PERMIT. IT IS NOT VALID UNTIL PROCESSED! <br /> <br /> <br />NAME OF APPLICANT -r;, 0 ~ ~ L 0... "'^-IL> <br /> <br />______ _L__ P'~' '- -:J-/___ <br /> <br />DATE.-!lJ.d3J-~~ <br /> <br />"----...--.-...------ <br />