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o'ID/a D d 7`f <br /> FIRE ALARM OR KITCHEN EXTINQUISHER PERMITS <br /> Please Check One: <br /> ❑ New Addition © Remodel ❑ Replace <br /> Job Site/Owner Information: <br /> Site Address: 2605 Wayzata Blvd W,Long Lake,MN 55356 <br /> Owner: <br /> WJM Properties LLC Mailing Address: 12550 Wayzata Blvd <br /> Minnetonka 55305 <br /> City: Zip: <br /> Home Phone: (952)473-6961 Alternate Phone: <br /> Contractor/Applicant Information: <br /> ADT Security Joe Robinson <br /> Contractor/App.: Contact Person: <br /> Address: <br /> 5910 Rice Creek Pkwy 700 State License #: TS00021 <br /> Shoreview 55126 07/31/12 <br /> City: Zip: Expiration Date: <br /> (763)792-6981 <br /> Phone: Alternate Phone: <br /> TYPES OF FIRE PERMITS <br /> ❑� Commercial—Fire Alarm ❑ Commercial—Fire Extinguisher <br /> Fire Systems Permit Fire Systems Permit <br /> *Con�tract)Price. $ ���� *Contract Price: $ <br /> ❑ Residential—Fire Alarm <br /> Fire Systems Permit <br /> *Contract Price: $ <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 the ill be in accordance with the approved plan. <br /> App Date <br /> Reset Form <br />