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<br /> ❑ New ❑ Addition Xi Remodel ❑ Replace
<br /> Site Address: Z Co C..J (.....)/I laid jJ(.tJ9
<br /> Owner: L..Ji4Y14'i 1 e&h.;1Z/ eL.-%a•S Mailing Address: Zoe U. (--iPim T1 iLLU©
<br /> City: OZQL9 L Zip: S-7 -.X i
<br /> Home Phone: Alternate Phone:
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<br /> Contractor/App.: c,Mkex 6R a 6seJ4. ti Contact Person: /lit/lax- Oa isrE
<br /> Address: S` fieri f,44) cx-% State License#:
<br /> City: 9f,))0iovrr/ Zip: MO Expiration Date:
<br /> Phone: 763'"36) Ste' Alternate Phone:
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<br /> ❑ Commercial—Fire Alarm V Commercial—Fire Extinguisher
<br /> Fire Systems Permit Fire Systems Permit
<br /> *G 1.p * 1;: II
<br /> *Contract Price:$ *Contract Price:$ 'L/ ..V ),c
<br /> ❑ Residential—Fire Alarm
<br /> FireS stems Permit
<br /> *ai c,6,1;'-.)
<br /> *Contract Price:$
<br /> F:-s*.," a9 '4..77:011Mt l a.i ,Iu_ R Cirt i aaa a a i? a s l.i -.@; ail.i t .: 'n":•.
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<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 /> manufac ers requirements;that I understand this is not a permit and work is not to start without a permit;
<br /> and '.t the .. ac : d. e with the approved plan.
<br /> Applicant Date
<br /> € d,. ' r{ " ¢ , r ',,, �/ ,W 6c,Q'c4 ✓ /y /0 l ...,e_ i
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