P - 84272Building �
Inspections �
763-572-3604
763-502-4977 FAX
DATE `O aoZ � �
SITE ADDRESS �) �1 `''1
THIS APPLICANT IS:
PROPERTY N�:
O�V'�IER/
� MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVH 1-1-2012
YOUR E-MAIL ADDRESS
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CONTRACTOR co�arrYrraME: CENTFRPOINT FNFRGY
SUBMITACOPYOF corrrACTPExsorr: JOANN ZINKEN
YOUR STATE STATE LICENSE # 2201 3346 EXP DATE 08�2��2012
LICENSE WITH ,a,DDt�ss: 9�2[1 FVFR(;RFFN Ri NW__SUiTE_ B c�� r.nnN RAPIDS STATE�ZIP55433
APPLICATION pHONE 763-785-5404 Fa,�c 763-785-5400
PERirIIT TYPE �CSINGLE FAMILY ❑ TWO FAMII..Y ❑ TOWNHOUSE
TYPE OF WORK: � '�W ��PLACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK
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FEES ARE BASED ON 510.00 PER FLYTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTaL NUrIBER OF EACH BELOW)
PROVIDE HE.aT LOSS CALCS PER bIAI�FU J 2006 ASHRAE HANDBOOK. c�
Equipment Installed MFG: ��' �"( �P MODEL: �4�X-� �� SIZEBN �
?vIFG: MODEL: STZEBTU
�'G: MODEL: SiZEBN
_A/C $2�.00 _FIREPLACE (GAS) $15.00 _GAS RANGE/OVEN 510.00
AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
_BOILER $35.00 �FURNACE $35.00 GAS UNIT HTR SI0.00
CHININEY LINER $10.00 _GAS DRYER $10.00 _POOL HEATER $35.00
DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR S1 �.00
-Number of fixtures @ $19.00 ! x $10.00 = $
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(MINIMUM H'r:� 54U Uu) i Ot31`= � .7 v ` `'` - �� i i Yl � t r «.t r � r �c .c;, v��- _- � :��•=`"� .. � �
THIS 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 app ' tion r a permit and wor is not to start without a permit; that the work ill be in accordance with the
approved plan in the case a w w'ch requir revi and agproval of plans.
SIGNATURE OF APPLICANT c PRIN'T NAME JOANN ZI NKEN D ��/� 1�
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APPROV.4I, INSPECTORS GNATURE DATE
; PLEASE NOTE: ' PARAT ARE RE UIRED FOR BUILDING, ELECTRI AL " MECHANICAL WORK
City of Fridley "
Building Inspections Department
6431 University Avenue NE, Fridley, NIN 55432
763-572-3604 FAX: 763-502-4977