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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 �