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�°i/y�`f `1 rr-b? <br /> : _, ,,,;; FIRE ALARM OR KITCHEN��T�N UISHER PERMITS ' <br /> � �sq <br /> � /(�,2 . �{Z- �v-��..d� <br /> Please Check One: <br /> ❑ New � Addition ❑ Remodel � Replace <br /> � Job Site/Owner Information: � � <br /> Site Address: .3 7'f5 `.S'I'�o��(:��- 1�.'� ✓e- <br /> Owner: (a� 51�pc��4 �—��I�a.�c,,,.L�,c���l�Mailing Address: ����)�I S" ShU.e I.,� 1�r�� <br /> City: ;=;� z�,xc� Zip: 5�, 3Ct I <br /> Home Phone: Alternate Phone: �/5�� �{�� - �`f 3 � <br /> Contractor/Applicant Information: : <br /> Contractor/App.: DlS��n ��'rr /�,,,��cr'-,�., Contact Person: ;:�i�� 1-k✓����� <br /> Address: j.�� �✓��=�t��� 5� N� State License#: i 5 O y 5�L <br /> City: M��r1e���•s Zip: �5"/i3 Expiration Date: 7/3//,���c'�� <br /> Phone: G,/.,?- �74 -',�z"�'� Alternate Phone: <br /> TYPES OF FIRE PERMITS <br /> � Commercial—Fire Alarm ❑ Commercial—Fire Extin�uisher <br /> Fire Systems Permit Fire Systems Permit <br /> *(Per UBC) *(Per UBC) <br /> *Contract Price: $ n �S� *Contract Price: $ <br /> ❑ Residential—Fire Alarm <br /> Fire Systems Permit <br /> *(Per UBC) <br /> *Contract Price: $ <br /> *Note: Permits are calculated with UBC Fee Schedule;submit application and we will call vou with a total fee for the <br /> permit. <br /> I herby apply for a Fire Alarm/Extinguisher Permit and 1 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 t the work wilt l�e in accordance with the approved plan. <br /> � ` �� q �/ � <br /> Appli nt Date <br /> Reset Form �lo�v�c���e� �/ 2 �/p 7 <br /> �--�-�� ��iv �/''�� <br />