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P - 42365Building Inspections ��` 763-572-3604 C� 763-502-4977 FAX �� MECHANICAL RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 2-]9-09 __ Permit No.' Received By: C!�� Da�t�Q� U L. 3 0 2 DATE �u.\ � a� C�-O (� YOUR E-iv1A1L ADDRESS SITE ADDRESS � DO C.D� S�' N� - THIS APPLICANT IS: ❑ OWNER �1CONTRACTOR PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PERMIT TYPE TYFE OF WORK: DETAILED NAME: �'Y'v Z � r� r w�-- • ADDRESS: �..O�OO LO� '�J� 1`�'� CITY �1r� `-e-�( __STATE��ZIP SSy3i. PHONE: b�a-0�3�' ��0� coMPA�vYNAME: CENTERPOINT ENERGY coNTacT pERSON: JOANN ZINKEN STATE LICENSE # BOND 22013346 EXP DATE ADDxESS:9320 EVERGREEN BLVD NW SUITE B ciTYC00N RAPIDS STATE MN zir55433 PHONE ��3-757-62�9 FAx 763-757-6701 �[NGLE FAMILY ❑ TWO FAMILY ❑ NEW ��PLACEMENT OF WORK �v�sl- �-�� ❑ TOWNHOUSE ❑ ALTERATION/REMODEL FEES ARE BASED ON $]0.00 PER FIXTURE, RCE�RE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) Equipment ]nstalled MFG: �E MODEL: s�' � V� ��00 -!� SIZEBTU C�,_LL'2� �� MFG: ��� MODEL: �"l I� P A�S a-i.� SIZE/BTU sZ`"{'fl�'l I(p S MFG: MODEL: SIZE/BTU l A/C $25.00 FIREPLACE (GAS) $I5.00 _GAS RANGE/OVEN $]0.00 AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 _NEW GAS GRILL $10.00 BOILER $35.00 �FURNACE $35.00 _GAS L1NIT HTR $10.00 CHIMNEY LINER $10.00 GAS DRYER $10.00 _POOL HEATER $35.00 DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $15 00 THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED � I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work wil] 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 re,c�uire review and approva] of plans. �� `�~' ' � PRINTNAME ROGER HOFFHEIN DATE -� -aq - ►o SIGNATURE OF APPLICANT � ��Q- City of Fridley Building Inspections Department / 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 e