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P - 42274Building ��a9°� Inspections 763-572-3604 763-502-4977 FAX DATE Ul. , � � SITE ADDRESS THIS APPLICANT IS: PROPERTY OWNER/ TENANT ao�d NAME: MECHANICAL RESIDENTIAL APPLICATION CITY OF FRIDLEY .03 r� ❑ OWNER YOUR E-MAIL ADDRES3 1Vt �7CONTRACTOR PHONE: �Ilo 3� S-L l' eZ.O Co r� d � Permit No. Received By: D����UG �� 2 TATErviN ZIP � SK3� CONTRACTOR coMPANYNa,ME: CENTERPOINT ENERGY SUBMIT A COPY OF coNTACT PExsoN: JOANN ZINKEN _ YOUR STATE STATE LICENSE # BOND 22013346 EXP DATE LICENSE WITH ADDx�ss:9320 EVERGREEN BLVD NW SUITE B ciTYC00N RAPIDS STATE MN Z�P55433 APPLICATION pHONE 763-757-6202 ____ FAX 763-757-6701 PERMIT TYPE TYPE OF WORK: DETAILED pESCRI �SINGLE FAMILY � TWO FAMILY ❑ NEW � REPLACEMENT OF WORK ❑ TOWNHOUSE ❑ ALTERATION/REMODEL � � FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH E OW) Equipment Installed MFG: �i,1.+t.�.�_ MODEL: �� �=U �p SIZE/BTU ���� dY� _ ` MFG: �J�_ MODEL: �� P PY103 C� SIZE/BTU OZ � �'�Xl , �A/C $25.00 AIR TO AIR EXCHANGEER $15 BOILER $35.00 CHIMNEY LINER $10.00 DUCT WORK $10.00 MFG: MODEL: . FIREPLACE (GAS) $15.00 FIREPLACE (WOOD) $35.00 �FURNACE $35.00 GAS DRYER $10.00 GAS PIPING $10.00 SIZE/BTU GAS RANGElQVEN 510.00 NEW GAS GRILL �10.00 GAS UNIT HTR $10.00 POOL HEATER $35.D0 VENTILATOR E15.00 THIS IS 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 case��all work which rec�uire review and approval of plans. SIGNATURE OF APPL[CANT �_�`" � � `�PRINT NAME ROGER HOFFHEIN DATE FS' I�" ( D ._ .. _ .., _ City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977