P - 44989Building
Inspections
763-572-3604
763-502-4977 FAX
DATE �Z � � � ` �
SITE ADDRESS �`�,
THIS APPLICANT IS:
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 2-19-09
YOUR E-MAIL ADDRESS
❑ OWNER K7CONTRACTOR
PROPERTY �TAME:
OWNER/ ADDRESS:
TENANT
� PHONE:
Permit No.:
Received By:
�i� ��� � ����
�� �
C1TY rr �' u STATEI�i�NZIP �7J y.
CONTRACTOR coMpa.NVNAnnE: CENTERPOINT ENERGY
SUBMIT A COPY OF coNTa.cT PERSON: JOANN ZINKEN
YOUR STATE STATE LICENSE # BOND 133 6 �{p DATE '
LICBNSE WITH ADDx�ss:9320 EVERGREEN BLYD NW SUITE B ciTYC00N RAPIDS srATE MN ZIP55433
APPLICATION pHONE 763-757-6202 FAX 763-757—f)%�l
PERMIT TYPE
TYPE OF WORK:
�INGLE F1IMILY ❑ TWO FAMILY
❑ NEW �,REPLACEMENT
DETAILED DESCRIPTION OF WORK
❑ TOWNHOUSE
O ALTERATION/REMODEL
_ . :;
FEES ARE BASED ON S10.00 PER FIXTURE� CEPT WHERE NOTED. FIXTURES: DICATE TO AL NUMBER OF EACH BELOW)
Equipment Instailed MFG: �� MODEL: �.R.� •� S]ZE/BTU _��,�
_,A/C $25.00
AIR TO AIR EXCHANGEER $15
BOILER 535.00
iCHIMNEY LINER S 10.00
DUCT WORK 510.00
MFG:
MODEL:
MFG: MODEL:
FIREPLACE (GAS) S15.00
~FIREPLACE (WOOD) $35.00
�FURNACE 535.00
�GAS DRYER $10.00
_ __GAS PIPING $10.00
SlZE/BTU
SIZFJBTU
GAS RANGE/OVEN 510.00
NEW GAS GRILL StO.OQ
GAS UNIT HTR Sl0.00
POOL HEATER 535.00
VENTILATOR 515.00
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 bnt 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 al] work whi h r un-e review and approval of plans. �
StGNATURE OF APPLICANT 1 l��"' �� � I PRINT NAME ROGER HOFFHEIN DATE �Z' I���
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977