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i . _ -. <br /> � New ❑ Addition ❑ Remodel ❑ Replace <br /> � <br /> SiteAddress: 2� � ��Q� V�� �� 1'�1'�� a5se�' <br /> �� <br /> T v��2��o��-�o � <br /> Owner: �/V\�v�. ' �; � Oc��►��Vlailing Address: 2.�{�7 ��'1�y U�10� Qd , <br /> r <br /> ���: 1 Ua�r�� �r� Z�p: 5 S�°�2- <br /> Home Phone: Alternate Phone: ��2 ��� �-fa7� <br /> ` `l �,� <br /> Contractor/App.: '(rt�Vv�p�/`' �2CV�f►� Contact Person: J�-�h-+- �•�'�" ` �h�` � <br /> Y ��l ��"�� <br /> 2�0 l ��evev� s �-� u� l <br /> Address: State License#: <br /> City: � 5 Zip: ��-I� O Expiration Date: 7 3� �� <br /> Phone: �0�2'���" `�17 � Alternate Phone: ��2 22�- �07Y�p <br /> � Commercial—Fire Alarm ❑ Commercial—Fire Extin uisher <br /> Fire S s[ems Permit Fire S stems Pemut ' <br /> *Contract Price:$ ��.�� *Contract Price: $ <br /> ❑ Residential—Fire Alarm <br /> Fire S stetns Permit <br /> * <br /> *Contract Price: S <br /> I herby apply for a Fire Alarm/Extinguisher Pemut and I acknowledge that the information above is complete <br /> and accurate;that the work will be in conformance with the Ordinances and Codes required by Minnesota <br /> State Building Code(MUBC)or Minnesota State Fire Code(MUFC)shall be installed and maintained 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 wil be in�ccordance with the approved plan. <br /> � ��' ,.►.� �wMo� �ut��'�Y� (p• 2`f- (fJ <br /> Applicant Date <br /> i,� Ip ti ; , <br /> I "' .� *�� �4r:. <br />