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. � <br /> . � FIRE ALARM OR KITCHEN EXTIN UISHER PERMITS <br /> . � <br /> Please Check One: <br /> ❑ New � Addition ❑ Remodel ❑ Replace <br /> *Installing a cellular unit to communicate to central station <br /> Job Site/ Owner Information: <br /> Site Address: 2500 Shadywood Road <br /> Owner: Mailing Address: <br /> City: Excelsior Zip: 55331 <br /> Home Phone: Alternate Phone: <br /> Contractor/Applicant Information: <br /> Contractor/App.: Total Life Security, LLC Coi�tact Person: Melinda Plzak <br /> Address: 321 Wilson Street NE State License #: TS646980 <br /> City: Minneapolis Zip: 55413 Expiration Date: July 2017 <br /> Phone: (612)676-2020 Alternate Phone: <br /> TYPES OF FIRE PERMITS <br /> 0 Commercial—Fire Alarm ❑ Commercial—Fire Extin uisher <br /> Fire Systcros Pennit Firc Systems Pern�it <br /> *(Per UB�) * (Per UBC) <br /> *Contract Price: $ 500.00 *Contract Price: $ <br /> ❑ Residential— Fire Alarm <br /> I�ire Svstcros Pcnnit <br /> x (Per UBC) <br /> *Contract Price: $ <br /> *Note: Permits are calc���`�'�''�chedule;' <br /> permit. <br /> I herby apply for a Fire Alarm/Extinguisher Pennit and I acknowledge that the infortnation above is coinplete <br /> and accurate; that the wark will be in conformance with the Ordinances and Codes required by Minnesota <br /> State Building Code(MUBC)ar Minnesota State Fire Code(MUFC)shall be installed and inaintained as per <br /> National Fire Protection Association (NFPA) 72 and 72E, 1996 edition, National Electrical Code and <br /> manufacturers requirements; that I understand this is not a permit and work is not to start without a permit; <br /> and that the work will be in accordance with the approved plan. <br /> 3/22/2016 <br /> Applicant Date <br />