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<br /> ^����0���� APPLICATION FOR
<br /> (�I'�'� c�� �R���_ _ � _ -
<br /> ` ; MAY ^ 9 1984 M�C��rin��l ����1t
<br /> GENERAL INFORMATION �
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<br /> 1. Vou �nay appC� 6u1 mechanicaL pcnmCto:.-by.,�id1'L.�_n:4�L,���n'. a1 Lhe Ca'ty o66icee. Mailed-.in penm<te a1e eubject to Ihe
<br /> poe4agc and handCing 6¢ea ehown beLow.
<br /> 1. Vennit c��de wiCl be etnt by netuan mai[ the eame day thc appLicatlon t6 aeceived. FERA117S ARE N07 VAL10 UNTIL VOU
<br /> RfCEIVE A PERMTT CARD. WOKK 61US7 N07 6EGIN k1N7IL THE PER11I7 CARD ]S POS7ED ON i'HE 10B SITE.
<br /> 3. When any new conetaue4ion on aemodeGing <e .�nvoLved, a eepanate buiLding pertmit muet be obta<ned.
<br /> I. ALC wunk muei be done <n aceoldance with State Bu<Cd<ng Code 2equtnemente.
<br /> 5. ALC wortk muaZ be <nepzeied �nough-tn and 6CnaC1. CaCL 473-7351 2�-houa notie2 hequirted.
<br /> 6. Houee Neating 7eet Recortd muet be eubmitted bebone 6inal - aee attached.
<br /> INSTRUCTIONS CompLete alf tteme on IhCe appLication. Compute .th¢ pelm<t 6v.e. S1gn and datt .the c¢atl6<catEon.
<br /> 7NCOlIVLE7E AVPLIC.l7I0NS WJLL NOT BE P20CESSED. 16 you have queai<one, eaGC 173-7357
<br /> UTALK- TN PERMITS Ap�.�y a� C�,�y U���.ce.a , 1335 Sau�h Bnown Road ( C�y. Rd. l46 )
<br /> MAIL- IN P�Rh1ITS �vle.�a�e bee - Ma�..� �o : P. U . Box 66 , Cn���a.� Bay, Mn. 55323
<br /> �** ** * * � ** ******* * *****�***�****�*********************� �*******�****** **x�*****
<br /> JOB SITE ' ' ` " �, � ��1. .�'_ �/�,�,_� _
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<br /> Occupancy 7ype: � aeaide Lal _ commeaeial; Othea
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<br /> .i ._� f! �j` G.C,�,�
<br /> Owner' s Name � � , � � • , Telephone Number
<br /> Mailing Address � „t`-
<br /> Contractor' s Name a:. � �� _f,��,� a (Y j�. � ( �. Telep one Number T�,1 "�� '� ?3
<br /> ��, �% - . --, �
<br /> Mailing Address ����:— � � — C�z� /�� � ��.��_��t ,��,� �k.��� ���N� S ����
<br /> ******X**��*************�***�************************ ****** ***************�**
<br /> HINIMUM FEE (520.00 per projact)
<br /> •►����1��f��}t�������N�Rf�����i��lriii�ii�it/i�r�ti��}�t�iri�t��fif�}i��i�►��I��trO��if��t�f���������\����M�t�\i�t��f�flf�t•
<br /> HEATING SYSTEMS $15.Q(�ench unit
<br /> FUEL � n�t. gas, � lp gas, _ oil, _ elect.
<br /> � other (specify if combination burner)
<br /> EpUIP. (if more than 1 unit per bldg., list each eeparately)
<br /> No. Type Btuh Input Drand Name Model No.
<br /> � � 9
<br /> � f. a. :urnace �0��/73 �l,`���,��� -��� ��L �� S
<br /> _ hw boiler �
<br /> ur.i: heater
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