P - 41774�uilding
Inspections
763-572-3604
763-502-4977 FAX
DATE 't ' � �
SITE ADDRESS _
THIS APPLICANT IS
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBIvIIT A COPY OF
YOURSTATE
LICENSE WITH
APPLICATION
PERMIT TYPE
TYPE OF WORK:
l��C�Il�llTICAI�
RESIDLNTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 1-1-2011
YOUR E-MAIL ADDRESS
�r vv� � �t,.. NE.
❑ OWNER I�CONTRACTOR
Permit No.:
I�eceived By:,
�.� '
� ;�
ADDRESS: _- ia.� I.JV �..° �01f� �C2. N E CITY �`�- � d��e-ti STAT���LIP��%.
PHONE: �, �D � ' S � �. � , I �
COMPANYNAME:�ENTERPOINT ENERGY
corrrACTrExsorr: JOANN ZINKEN
STATE LICENSE # BOND �ZZO1334C) EXp Dp'I-E 08�2��201.�_
.�D�ss: 9320 EVERGREEN BLVD SUITE'' B' . crrY COON RAPIDS STATEMN z�55433
PHONE _ �I L� '� SS ' S�IO � FAX _� �13 ' % $ S ` S �G�
�SINGLE FAMILY ❑ TWO FAIvII�..Y
❑ NEW �[REPLACEMENT
❑ TOWNHOU3E
❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF Wpx� ZV�'�G�•`� ,\�Cp�+e �1�.� T�„�¢L(,1 Q
Q�c� (1 i� C��d; �i o✓1 e r
FEES ARE BASED ON 510.00 PER F�CTLRE, EYCET'T WTiERE NOTED. FI?�TIIRES: (I1��ICATE TOTAL NLMBER OF EACH BELOVI�
PROVIDE HEAT LOSS CALC'S PER MANiI J 2006 ASHRa,E HANDBOOK ^
Equipment Installed MFG: ��L� MODEL: 4 C' 0� s�z�sTV L D� DUv
MFG: � MODEL: _��� i��I` OO�`'� SIZEBN iZ� ��Cci
MFG: MODEL: SIZEBTU
�A/C �2�.00 �FIREPLACE (GAS) $15.00 �GAS RANGE/OVEN $10.00
AIR TO AIIt EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
_BOII,ER $35.00 �FURNACE $35.00 ^GAS iJNIT HTR $10.00
_CHIIviNEY 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 @ $15.00 x $15.40 = $
Number of fixtures @ $35.00 � x $35.00 = $ �'� • ��
State Surcharge = ' ? $ 5.00
(MINIMUM FEE 540.00) _ Total = $ t�.�P�� ��
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building 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 applicatio r a permit an ork is not to start without a permit; that the work will be in accordance with the
approved plan in the case of all w k hi equ'r � e and approval of plans.
SIGNATUREOFAPPLICANT RINTNAME JOANN ZINKEN Da� /I�9/��
APPROVAL INSPECfORS SIGNA " DATE
PLEASENOTE: SEPA E`PERMI RE UIRED FOR BUILDING, ELECTRICAL AND
City of Fridley
, Buil ing Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
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