Office Use Only
Notes: Scan
Permit Total:
$ _____________
COMMERCIAL
BUILDING
Permit Application
City of Elk River
Building Safety Division
13065 Orono Parkway NW Elk River, MN 55330
763.635.1060 E-mail: Building@ElkRiverMN.gov
Site Address: __________________________________________________ PID #________________________________________
Subdivision _____________________________________________________________ Lot ________ Block ________
Property Type: Commercial Industrial Institutional
Construction Type: New Addition Remodel Repair Alteration Other ____________
The Applicant Is: Owner Contractor Other ____________________
Property Owner:
Name ______________________________________________________ Phone ______________________________________
Address ____________________________________________ City _________________ State ________ Zip _____________
Email _______________________________________________________________
Contractor:
Business Name ______________________________________________ License/Bond _________________________________
Address ____________________________________________ City _________________ State ________ Zip _____________
Office Phone _________________________________ Cell _______________________________
Email _______________________________________________________________
Architect/Engineer:
Name _______________________________________________________ Phone ______________________________________
Address ____________________________________________ City _________________ State ________ Zip _____________
Email ___________________________________________________________
PLEASE COMPLETE OTHER SIDE OF APPLICATION
__________________________________________________________________________________________
Office Use Only
Permit fee: _______________ Plan check fee: ____________ State surcharge fee: ______________ Sewer fee: ______________ License fee: ________________
Construction type: _________ ___ Occupancy group: ____________ Division: ___________ Total SQ FT___ __________ Max Occupancy Load_____________
Approved by: ______________ Date: ____________ Called or L/M Date: _____________ Int. ______
Last Modified 11/2018
Date: ______________________
Permit #:______________________
Date: ______________________
Permit #:______________________
Detailed description of work:
* Please note: Separate permits are required for electrical, plumbing, and/or mechanical work.
Total Job Valuation $ _____________________
Payment Options:
Call me for credit card payment (If different than above, please note: Phone: ______________________________________)
Send Check (Please make checks payable to the City of Elk River)
Pay in person via Credit Card, Check, or Cash
Receipt of Permit Options:
Email permit (If different than above, please note: Email : ______________________________________________________)
Pick up in person (All permits with plans needs to be picked up)
This is an application for a permit It is not valid until processed
I hereby apply for a Building Permit, and I acknowledge that the information above is complete and accurate. I understand this is not a permit and work is
not to start without a permit.
I understand and hereby agree that the work for which the permit issued shall be performed according to; (1) the conditions of the permit; (2) the
approved plans and specifications; (3) the applicable city approvals, ordinances, and codes; and, (4) the state building/mechanical codes and regulations.
I understand that the permit will expire, and become null and void if work is not started within 180 days, or if work is suspended or abandoned for a
period of 180 days any time after work has commenced; and, that I am responsible for ensuring that all required inspections are requested in conformance
with the state building code.
____________________________________________________________________________________________________________
Signature of Contractor/Responsible Party Print Name Date
____________________________________________________________________________________________________________
Signature of Property Owner Print Name Date
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