P - 35506BU11C�1T1�
Inspections
763-572-3604
763-502-4977 FAX
DA� 3•aK-►(
SITE ADDRESS _
THIS APPLICAN'I' IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOURSTATE
LICENSE WITH
APPLICAT'ION
PERMIT TYPE
MECI�ANICAL
RESIII�ENT�AL APPLICATION
CITY OF FRIDLEY
❑ OWNER
E-MAIL ADDRESS
V
CITY F' Y" 1'�
Permit No.:
Received By:
!�:.-;-
A"f��IP
PHONE: %(e 3- S�% I" S� '�
co�arrYrr�: CENTERPOINT ENERGY
corrrACrPExsorr: JOANN ZINKEN
sTA� r.icErrsE # BOND #22013346 EXp DATE 08/20/2011
nDDx�ss: 9320 EYERGREEN BLVD SUITE � B crTY COON RAPIDS sTa�NIN z�55433
PHONE 763-757-6202 F� 763-757-6701
FAMILY ❑ TWO FAlvIILY
TYPE OF WORK: I � �' ��PLACEMENT
❑ TOWNHOUSE
❑ ALTERATION/REMODEL
DETAILEDDESC IPTdONOFWORK 3ins�n.\l I�L°� IOtL+C �k-I.�..r✓1��.�� 0.r1� G].ir
-� � �
:�� �e�'
FEES ARE BASED ON S10.00 PER F�TLiRE, EYCEPT WHERE NOTED. FI?�'TURES: (Il��ICATE TOTAL lv'L7A�ER OF EACH BELOVI�
PROVIDE HE�.T LOSS CALC'S PER MAi�UAL J 2006 ASHRAE HANDBOOK
Equipment Installed MFG: '�Q �,l.ue� MODEL: ��,�i�m "�e S BN �'�i0
MFG: �y,�_ MODEL: u 1'iPM • Oa� SIZEBTU O"'Z' �-o:I i S�c+'
MFG: NIODEL: SI�E/BTU
�A/C $25.00 TFIREPLACE (GAS) $15.00 �GAS RANGEIOVEN $10.00
_AIR TO AIlt EXCHANGEER $15 _FIREPLACE (WOOD) $35A0 _NEW GAS GRILL SI0.00
_BOILER 535.00 �FURNACE $3�.00 _GAS tJNIT HT'R �10.00
_CHIhINEY LINER $10.00 _GAS DRYER $10.00 POOL HEATER $35.00
DUCT WORK $10.00 GAS PIPING $10.00 ^VENTILATOR 515.00
Number of fixtures' @ $10.00 ' x $10.00 = $ ' = ,
Number of fixtures @ $.
Number of fixtures @ $.
i --, a ac�.w
1 :X $35.�0 .
��
�W
State Surcharge = $ 5.00
SMINIMUM FEE $40.00)' Total = $ ��3ii ��
THIS IS AN APPLICATION FOR A PERNIIT-NOT VALID UNTIL PROCESSED
I hereby app3y for a buildin; permit 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 d work is not to start without a permit; that the work will be in accordance with the
approv�d plan in the case of tl w rk w i r ire r view and approval of plans.
SIGNATUREOFAPPLICANT�'i�//ylNj � PRINTNAME JOANN� ZINKENL -, �_ DATE 3����'`�
APFROVAL INSPEC'f01
PLEASE NOTE:'
City of Fridley
, ilding Inspections Departmen#
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977