P - 47341Building MEC�iA�ICA� Permit No.: '� ° a
Inspectio�s RESIDLNTIAL APPLICA�'ION Receivecl By: ��
763-572-3604 CITY OF FRIDLEY ����e��"' ° � � ����
763-502-4977 FAX EFFECTTVEi-i-�oii
DATE Q` I d`�, YOUR E-MAI�L CADDRESS
SITE ADDRESS �� �� aC SdV1 vT NE
THIS APPLICANT IS: ❑ OWNER L•}CONTRACTOR
PROPERTY NAME: �Gt. �C. � G�. 5C>Y1
OWNER/ ADDRESS:�.� �GtL',ICSd1n S'�'N�CITY YiJI��I STAT'$Ir�NZIPS
TENANT PHONE: � �3 , a� o� oo a�
CONTRACTOR co�ArnN�: rENTERPOrNT ENERCY
SUBMIT A COPY OF corrT.acT pERSON: JOANN ZI NKEN
Youx sTa.� sT.a� LlcErrsE # BUND #22013346 � DA� 08/20/2011
LicErrsE wiTx ADD�ss: 9320 EVERGREEN BLVD SUITE' B c�TY COON RAPIDS sTaTEMN zrr55433
APPLICATION PHONE _ ! (Q �j° � �� ' S�C��� FAX _ �(G .�"'� � 'S� ��
PERMIT TYPE �sr1vGLE Fr�vur.Y ❑�rwo Fa��til.Y ❑ TOWNHOUSE
TYPE OF WORK: � ��' � �PLACEMENT $IALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK �,,G �4.@G QC�S c�.r y�r ���� VGL.�VC... �� SC�tw� v�
��r cti.� 4ti.v�c� ��„c,r 1 a�-� -��. U�,►n-�
FEES ARE BASED ON 510.00 PER FIXTL�RE, E�CEPT WHERE NOTED. FIXTLTiES: (IlYDICATE TOTAL NUVIBER OF EACH BELO��
PROVIDE iiEAT LOSS CALC'S PER b'LINUAL J 2006 ASHRAE HANDBOOK
Equipment Installed MFG: MODEL: SIZEBTCT �
IvfFG: MODEL: SIZEBN
MFG: MODEL: SIZEBTU
A/C $2�.00 _FIREPLACE (GAS) $I5.00 _GAS RANGE/OVEN $10.00
_AIR TO AIR EXCHANGEER $IS FIREPLACE (WOOD) $3�.00 _NEW GAS GRILL $10.00
BOII.ER $3�.00 FURNACE $3�.00 GAS UNIT HT1Z $10.00
CHIhINEY LINER 510.00 ✓GAS DRYER $10.00 POOL HEATER $3�.00
DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $15.00
Number of fixtures @ $10.00 � x $10.00 = $ " � p, �
Number of fi:ctures @ $15.00 x $15.00 = $
Number of fixtures @ $25.00 x $25.00 = $
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = 5.00
MINIMUM FEE $40.00) Tot = $ �• ��
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID tTNTIL PROCESSED
I hereby apply for a buildin� 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 application 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 work which requires revi and approval of plans.
SIGNATUREOFAPPLICANT �C/YPRINTNAME JOANN ZINKEN DATE
1'� .�e���r
APPROVAL INSPECTORS S NATURE DATE
' PLEASE NOTE: SEPARATE 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