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. � i FIRE ALARM OR KITCHEN EXTINQUISHER PERMITS <br /> aoi�-�a�d7� <br /> ��3�11 <br /> Please Check One: � �� <br /> `� New ❑ Addition ❑ Remodel ❑ Replace � <br /> / <br /> Job Site/Owner Information: <br /> '�1���� <br /> Site Address: ���00 — �� �c9t., � <br /> Owner: / KiN�I� L�T/t�2�N C�u� Mailing Address: O��'O � �� �`��- N <br /> c�ty: Lo,�C� C.�-kE zip: ��� �� <br /> Home Phone: Alternate Phone: �,SZ-' �73�S5 7? <br /> EF• �� <br /> Contractor/Applicant Information: <br /> Contractor/App.:/�2Tft[,Ptic.A F��E�'.�tU�c:tir Contact Person: � �� "'"�S <br /> Address: �1����.�� ST State License#: <br /> City: � (itJ�' Zip: SS�3S Expiration Date: <br /> Phone: ��Z.' gq3' Oq�S Alternate Phone: <br /> TYPES OF FIRE PERMITS <br /> ❑ Commercial—Fire Alarm �inmercial—Fire Extin�uisher <br /> Fire Svstems Pennit Firc S��stems Permit <br /> * (Per UBC) '�(Per UBC) <br /> x Contract Price: $ x Contract Price: $ �BJ��•�� <br /> ❑ Residential—Fire Alarm <br /> Fire Sy��tcm�Pcrmit <br /> * (Per LIB�} � <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 Alann/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 /> ma ufacturers requirements;that I understand this is not a permit and work i not to start without a permit; <br /> and at the work will be i accordance with the approved plan. <br /> __ Z l( <br /> Applic Date <br /> Reset Form <br />