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p FIRE ALARM OR KITCHEN EXTINQUISHER PERMITS 0201o� - aoas,`S Please Check One: 3; ` ✓ New Addition "Sq./5- c 5 ❑ ❑ ❑ Remodel ❑ Replace Job Site/Owner Information: z R7(111e 875 Wayzata Blvd Orono MN 55391 SVS„ Site Address: Orono Senior Housing Owner: Mailing Address: City: Zip: Home Phone: Alternate Phone: Contractor/Applicant Information: Northland Fire&Security Greg Youngs Contractor/App.: Contact Person: 990 Lone Oak Rd N/R Address: State License #: Eagan 55121 City: Zip: Expiration Date: Phone: (651)287-8555 Alternate Phone: TYPES OF FIRE PERMITS 1. ❑ Commercial—Fire Alarm E Commercial—Fire Extinguisher Fire S stems Permit Fire Systems Permit * 1:.., ; 1 * (Pe ) *Contract Price:$ *Contract Price:$2,900.00 ❑ Residential—Fire Alarm Fire Systems Permit * (Per UBd) *Contract Price: $ *Note: Permits are calculated with UBC Fee Schedule;submit application and we will call you with a total fee for the MEM I herby apply for a Fire Alarm/Extinguisher Permit and I acknowledge that the information above is complete and accurate;that the work will be in conformance with the Ordinances and Codes required by Minnesota State Building Code(MUBC)or Minnesota State Fire Code(MUFC)shall be installed and maintained as per National Fire Protection Association (NFPA) 72 and 72E, 1996 edition, National Electrical Code and manufacturers requirements. that I understand this is not a permit and work is not to start without a permit; an hat the work will be in ccordance with the approved plan. 01/24/12 App ' Date �: � eset Form ;