P - 48296Building
Inspections
763-572-3604
76�-502-4977 FAX
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�S�D��'rT'i'�A�L �PPLIC�rI'I�l�T
CITY OF �RIDT��Y
EFFECTIVE I-1-?Ol l
DATE I`� S` I YOUR E-h�tAIL ADDRESS
SITE ADDRESS G�.l.�.�� �
THIS APPLICANT IS: ❑ OWNER e]CONTRACT
PROPERTY NAME:
OWNER/ ,aDDxaSS: qq(,j. 1�1t,� 0.��t �,.a
TENANT x
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CITY
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Received By
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CONTRACTOR co�Ann rr.a���: GENTERPOINT ENERCY
SUBMIT A COPY OF corr-ra.cT PExsorr: JOANN ZINKEN
YOUR STATE s �,�.� LicErrsE � gOND #22013346 � D.art 08/ 20/ 2011
LICENSE WITH �Dx�ss: 9320 EVER6REEN BLYD St1IiE � B crrY COON RAPIDS sraraMN z�55433
APPLICATION PHOTE �� 7r� c�n� F� -xc� �czs�ni _11 y
r - - --._.. � _ _
PERi�ZIT TYPE
TYPE OF WORIt:
DETAILED DE
%SINGLE FAI�IILY � TWO FA,vIILY
❑ NEW �REPLACE2vIENT
OF WOF.K
❑ TOV�TiHOL'SE
❑ ALTERAT]ON/REMODr'7..
FEES �.RE BASED ON S10.o0 PER FL\TL"RE, EYCEPT R'E�RE hQTED. FL�TL'RES: (L�'DICaTE TOT4L?vZT\�IBER OF EaCH BELO��
PRO��E FiE.4T LQSS C�L.C'S PER ivL�..�L; �I, J 3006 ASh'R� F H4.��BOOK
Equipment Installed ivL�G: MODEL: SIZJBN
Ivt"rG:
uf�i�3�i�
SIZEIBN
1vLFG: MODEL: SIZE/BTU
_A/C S?5.00 _FIREPLACE (GAS) �15.00 i%GAS RANGE/OVEN �10.00
AIR TO AIR EYCHANGEER �IS FIIZFPL.4Cc (WOOD) i3�.00 NEW GAS GtZILL $10.00 �
BOILER �3�.00 FURN:4CE 53�.00 _GAS UNiT hiR $10.00
_CHIDINEY LNER S10.00 G.4S DRl'�R i10.00 _POOL I-�.ATER i35.00
DLCT WORi: $10.00 GA5 PIPING �10.00 VEVTII..4TOR 515.00
Number of fixtures cr $I O.00 � x$10.00 =$ 10 , OC� _
Number of fix:ures @ $1�.00 x �15A0 = $
Number of fixtures @ $2�.00 x $25.00 = �
NumbeT of fixr,�res @ $3�.00 x $35.Q0 = $
State Surcharge = $, ` 5.00
(MINIMUM FEE $40A0) Total � � d� '
THIS IS AN APPLICATION FOR A PER'vIIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the infortnation 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 f understand this is
not a permit but only an application for a perm' and work is not to start without a permit; that the work will be in accordance with the
approved plan in the case of wor which quire revi w and approval of plans.
SIGNATURFOFAPPLICANT PRINTNAME JORNN ZINKEN / � DATE I'e�s ��
� . • A � �� . /'1
;NATURE f .� `� DATE
ARATE RE UIRE FOR BUILDING, ELECTR :
City of Fridley
uilding Inspections Department
6 1 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977