P - 84368Building � MECHANICAL
Inspections c��lo`� �SIDENTIAL APPLICATION
763-572-3604 CITY OF FRIDLEY
763-502-4977 FAX EFFECTIVE 1-1-2012
DATE 1 � I( S � Z YOUR `E-MAIL ADDRESS
SITE ADDRESS ,�� C� (�i C. f C_ v'iZ N�
THIS APPLICANT IS: ❑ OWNER �(CONTRACTOR
PROPERTY N,e,ME; O � OC> �.Jo
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ow�vEx� �Dx�ss: l3i O � r,c s i c� ��rr. N� crrx �r i(-e�. STAT�YINLIP��;
TENANT pHONE: 1�0 3` i�
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CONTRACTOR co�arrxx.a�: CENTFRPOTNT ENER�Y
SUBMIT A COPY OF corrTacr PERSOrr: JOANN ZINKEN
YOURSTATE STATELICENSE# 2201 3346 EXPDATE 08�2��2�12
L�cErrsE w1� �Dx�ss: 9320 EVERGREEN BL NW SUITE B crrY COON RAPIDS STATEI�I _ZIP�5433
APPLICATION pHONE 763-785-5404 F�x 763-785-5400
PERMIT TYPE
TYPE OF WORK: I � �'
DETAILED DESCRIPTION OF
FAMILY ❑ TWO FAMII.Y ❑ TOWNHOUSE
❑ REPLACEMENT �ALTERATION/1tEMODEL
FEES ARE B�1SED ON 510.00 PER FLYTURE, EXCEPT �VHERE NOTED. FIXTURES: (INDICATE TOT.�L NU�iBER OF EACH BELOV►�
PROVIDE HEAT LOSS CALC'S PER �L-11VUAL J 20Q6 ASHR.�E HANDBOOIG
Equipment Installed MFG: MODEL: SIZEBN
MFG: MODEL: SIZEBTU
MFG: MODEL: SIZEBTU
_A/C $25.00 FIREPLACE (GAS) $15.00 GAS RANGEIOVEN $t0.00
AIIt TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 _NEW GAS GRILL $10.00
_BOILER $35.00 _FU��itcCE �35.00 GAS UNIT HTR $10.00
CI��1vINEY LINER $ I 0.00 _��S DRYER $10.00 POOL HEATER 535.00
DUCT WORK $10.00 GAS PIPING $10.00 VE�"CII,ATOR $15.00
Number of fiactures @ $10�.00 �� x $10.00 = $_i O . ����C�G , � � " ' � � ' � � � � �
Number of fi .
Number of fi
State
,.�,..,.� �, W.�..,,, ,..�..,.,,� W
xtures @ $25.00 x $25.06 = $ '
�tures @ $35:00 ' x $35.00 = $ '!
��e = $ 5.00
0
J
(MI UM FEE $40.OQ) Total = $ � . �� (Yi i �1 � M� r-, �. inc� v-� � 5 �'�,�i...�.t �ti"� �.��r-ci �
"' 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 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 applic tion 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 of 1 o which re uires re ew and pprov of plans.
SIGNATURE OF APPLICANT P Ar� JOANN ZI NKEN DATE O �S �L
APPROV.4L L1'SPECTORS SI ATURE DATE ��
I PLEASE NOTE: ' SEPARATE PERMIT RE' QUIRED F;�OR BUILDING, ELEG'IRI AND ECHANICAL WORK .`
l City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977