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t � <br /> � � <br /> ' � FIRE ALARM OR KIT�HEi�i EXTINQUISI-IER PERI�IT� ,,,,�,,, ;�.� <br /> �.� <br /> Please Check�ne: � � � � � �� <br /> ❑ New ❑ Addition p Remodel ❑ Replace <br /> .Ioh Site f Owner Infarmation: <br /> Site Address: ���� ,S�dr� I�e �l' �'G' � <br /> Owner: �e�//� ��Cdh"�y Mailing Address: ✓?�(� -��u r� d�h �� <br /> c�ry: �ir�n�ap�G�s z�p: 5S� � -� <br /> Home Phone: �I Z `b�� �" �lU Alternate Phone: <br /> Contractor/Applieant Information: <br /> Contractor/App.: J�'r���I�r s r�,�r Contact Person: �/'t? � �/��v„S <br /> Address: fC� � T � � �tate License #: 1 J� ��� �T <br /> City: o Zip: SJ��� Expiration Date: <br /> Phone: 7L 7 ' � '�� '�Z�� Alternate Phone: <br /> T� <br /> TYP S OF FIRE PERMITS <br /> (� Commercial—Fire Alarm ❑ Commercial—Fire Extin�uisher <br /> / Fire Sys[ems Permit Fue Systems Permit <br /> **(���t��� L 1�1� � *�P���;�� <br /> Contract Price: $ —:f � Contract Price: $ <br /> ❑ Residential—Fire Alarm <br /> Fire Systems Permit <br /> * ��`�1"��i�� <br /> * Contract Price: � <br /> *:Nate: ,F�its are calcutated�t,,fi�ISC ee 5c�tedute,su' ,rt applic�tian and we wttl�atl yau with�.tciia[fee£or f;�ies <br /> permit. � . _ . <br /> �x.� � l <br /> I herby apply for a Fire Alarm/Extinguisher Permit 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 t e work will be in accordance with the approved plan. <br /> � � 5 �Z � � <br />