P - 42739Building
Inspections Ck-�
763-572-3604
763-502-4977 FAX
DATE P'�w�_
SITE ADDRESS _
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
S � MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 2-] 9-09 _
010
l �i �r,
❑ OWNER
NAME
YOUR E-MA]L ADDRESS
�7CONTRACTOR
��
ADDxESS: �"12-'1 3r� Sk NE CiTY
PHONE: ZoS�' GC�� - a3q �
Permit No
Received By:
D���,.��
TATEW��ZIP �4 ��
CONTRACTOR comPANYNaME: CENTERPOINT ENERGY
coNTACTPeRSON: JOANN ZINKEN
SUBMIT A COPY OF BOND 22013346
YOUR STATE STATE LICENSE # EXP DATE
LICENSE WITH ADDRESS:9320 EVERGREEN BLVD NW SUITE B ciTYC00N RAPIDS STATE MN z►r 55433
APPLICATION pxoNE ��3-757-620 FAx 763-757-6701
PERMIT TYPE
TYPE OF WORK:
�SINGLE FAMILY � TWO FAMILY
❑ NEW �EPLACEMENT
DETAILED DESCRIPTION OF WORK
❑ TOWNHOUSE
❑ ALTERATION/REMODEL
FEES ARE SASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BEL W)
Equipment]nstalled MFG��e�,��.�.� MODEL: U'RPY1�i �o'Z�{ SIZE/$TU eZ�'n,5
L A/C $25.00
AIR TO AIR EXCHANGEER $15
BOILER $35.00
CHIMNEY LINER $10.00
DUCT WORK $10.00
MFG:
MODEL:
MFG: MODEL:
FIREPLACE (GAS) $15.00
F[REPLACE (WOOD) $35.00
FURNACE $35.00
GAS DRYER $10.00
GAS PIPING $10.00
SIZE/BTU
SIZE/BTU
GAS RANGE/OVEN $10.00
NEW GAS GRILL $10.00
GAS LJNIT HTR $10.00
POOL HEATER $35.00
VENTILATOR $ I5.00
THIS 1S AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building pennit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the
approved plan in the cas�all wo�r�k w� h re,c�uu-e review and approval of plans.
SIGNATURE OF A�tLICANT +�
� U "`f'°'PRINTNAME ROGER HOFFNEIN DATE G t O
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977