P - 35175Building 1VI�C�]tANIC�.L Permit No.: '�`jll"� V�
Inspections RESIl��+ N�'IAL AP�'L�C:A�'I�N Recei�ed By: 1
763-572-3604 CITY OF Fl��LEY D��'a
76�-502-4977 FAX �FFECTTVS i-i-?oii
DATE � ` ,, � �, YOUR E-MAIL ADDRESS
SITE ADDRESS ��j� � r'LWL L° � y �+C�.1i�G N�
THIS APPLICANT IS: ❑ OWNER f�CONTRACTOR
PROPERTY
OWNER/
TENANT
l7�1�r�
CITY
CONTRACTOR co�ArrYrra.ME: CENTERPOINT ENERGY
SUBMIT A COPY OF coN�rACT PExsorr: JOANN ZI NKEN
YOUR STATE STATE LICENSE # BOND �ZZO�3346 EXP DATE �8�2��2�1 �
LtcErrsE vv�Tx �Dx�ss: 9320 EVERGREEN BLVD SUITE B crrY COON RAPIDS STATFMN zir55433
APPLICATION pHONE �63-757-6202 F,� 763-757-6701
PERMIT TYPE I/"`"NGLE FAMILY ❑ Tw0 FAMILY
TYPE OF WORK: I��W iG��PLACEMENT
❑ TOWNHOUSE
❑ ALTERATION/REMODEL
DETAILED E CRIPTION OF WORK �}a.�\ 1 l��C �"L�Y"P1�,G� ! U�r1C' C�,1 r'"
�� �i��101f1t 1�"
FEES ARE BASED ON 510.00 PER FI�`CTL`RE, EYCEPT WHERE NOTED. FIXTliRES: (Il�'DICATE TOTAL NiTiVIBER OF EACH BELO�
PROVIDE HE.4T LOSS C.aI,C'S PER T4ANU J 2006 ASHRAE Hr1NDBOOK
EquipmentInstalled MFG: ��,� MODEL:��.r�,b(p��IZF��
MFG: Q MODEL: Ap oay SIZE/BTU R��
✓A/C $25.00
AIR TO AIR EXCHANGEER $15
BOILER $35.00
CHIIvINEY LINER $10.00
DUCT WORK $ ] 0.00
:r of$xtures @ $15.00
NffG:
MODEL:
_FIREPLACE (GAS) Sli.00
_FIREPLACE (WOOD) $35.00
J,.FURNACE $35.00
GAS DRYER $ ] 0.00
GAS PIPING $10.00
_$
_$
�� �
SIZEBT[3
GAS RANGE/OVE.N $10.00
NEW GAS GRILL 510.00
GAS LRVIT HTR $10.00
POOL HEATER $35.00
VENTILATOR 515.00
Number of fixtures @ $35.00 � . x $35.00 = $��
State Surcharge = ' $ 5.00
MINIMUM FEE $40.00 Total = $ � �" � �
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
__ I hereby apply -for a buiiding permit and-I acknowledge that xhe information above is complete and accurate; that.the work wili 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 applicatio or ermit and work is not to start without a permit; that the work will be in accordance with the
approved plan in the case of all w� wh'�1� r uires� �ie��nd approval of plans. � � 1 ��
SIGNATURE OF APPLICANT
APPROVAL INSPECTORS SIGN TRE
PLEASE NOTE: SEPARATE`
DA
�City of Fridley
B mg Inspections Department
University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
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