P - 45828Building lr/j�(�����(�AI, Pennit No.
Inspections �5����T�AL AP�L�CAT�Q� Received By.
763-572-3604 CI�'Y OF FRI�LEY Date � �� �► .
763-502-4977 FAX EFFECTIVE 1-1-2011
DATE � �� `, r YOUR E 1L ADDnRE,S,�.S_
SITE ADDRESS �SS�p C E?Y'1 S`�� �v �-" \ V t---
THIS APPLICANT IS: ❑ OWNER e}CONTRACTOR
PROPERTY NpME — � �n �o S
OWNER/ ,a,DDRESS: �p e Ct.� U TY Y'\ �'�- STATE�NZIP SS4�
TENANT PxoI3E. r{( n�' S� l' g� L
CONTRACTOR coNrnAr�rrA�: CENTERPOINT ENERCY
sus�T A coPY oF corrr.acT PERSON: JOANN ZI NKEN
YOUR STATE sTA� LicErrsE � BOND #22013346 EXP DATE OH�ZO�ZO11
LlcErrsE wlTx ADD�ss: 9320 EVERGREEN BLVD SUITE B c�rY COON RAPIDS sTATEMN z�P55433
a.PPLZCaTTON PxoNE 763-757-6202 FAx 763-757-6701
PERMIT TYPE �-SNGLE FAMILY ❑ TWO FAMILY ❑ TOWN�IOUSE
TYPE OF WORK: � �W �C�PLACEMENT ❑ ALTERATION/REIvIODEL
DETAIL D DESCRI TION OF WORK a�E' i('1, �E ,�� �'E' 1V�1°
_ ` -�o�.
FEES ARE B?.SED ON 510.00 PER FLYTLRE, EYCEPT WFIERE NOTED. FIhTL�RES: (I1��IC:�TE TOTAL NUI�IBER OF EACH BELO�V)
PROV"IDE HE.aT LOSS C4LC'S PER �I��tiAI, 3 2006 AS�IR?iE HANDBOOK
Equipment Installed Iv1FG: MODEL: STZEBTU
iviFG: MODEL: SIZEBTU
IvIFG: IviODEL: SIZEBTU
_A/C $2�.00 _FIREPLACE (GAS) $1�.00 sAS RANGFJOVEN $10.00
_AIRTO AIREXCF.ANGEER$15 FIREPLACE (WOOD)$35.00 _NEW GAS GRILL $10.00
BOILER $3�.00 FURNACE $3�.00 GAS UN1T HTR $10.00
CHIl�INEY LINER $10.00 G.4S DRYER $10.00 POOL HEATER $35.00
DUCT WORIC $10.00 GAS PIPING $10.00 VEN°I'ILATOR $ I�.00
Number of fixtures �a $10.00 � x $10:00 = $ C.�. �C�
Number of fixtures @ $1�.00 x $15.00 = $
Number of fixtures @ $25:00 x $25.00 = $
Number of fixtures @ $35.00 x $35.00 = $
State Surchar�e = ' ��
MINIMUM FEE $40.00) ota1= $ `��� ��
THIS IS AN A�L7�A"176N FOK A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply-for a building permit and I acknowled�e 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 app ' ation 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 o a w which requires revie and approval of plans.
SIGNATUREOFAPPLICANT PRINTNAME JOANN ZINKEN DATE�-y��`s-`--
APPROVAL INSPECTORS NATURE DATE
' PLEASE NOTE: S PARATE PERMITS ARE RE UIRED FOR BUILDING; ELECTRICAL AND MECHANICAL WORK'
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
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