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❑ New ❑ Addition Remodel ❑ Replace <br /> Jc 4Sal; /kQ file nf0jrinaft& <br /> Site Address: X830 (tl zaytet BJH-'d Le„y 4,/e._ AO -5-s-30 e <br /> Owner: Otte u 3r oS Mailing Address: 2380 tAlkYzaick. 84'd- <br /> City: L07 take , Zip: , 53"6 <br /> WeRc... <br /> Phone: 7 S').'74/5-- ?1 S-7 Alternate Phone: <br /> i)104idz / ,ij1aca it r�aa i <br /> Contractor/App.: XTR f LM t e i ca I St`Contact Person: . <br /> e ii- c i'L/ <br /> Address: all 1,4it9 - £co//bcd 1T State License#: CA Oy`17S <br /> City: Aktuse flit Zip: SC36 Expiration Date: a 1 i.1,Ia./a._ <br /> mAA„ <br /> Phone: fof)-7of-6)t 7 Alternate Phone: yg'2-5,66 ,Sr777 <br /> _c :iti rs ' ° � �t <br /> a a :�s� 6 Ii ,a , : ,.kn,i� ,. p , :, x . -t'.. . � <br /> `tom Commercial—Fire Alarm ❑ Commercial—Fire Extinguisher <br /> Fire Systems Permit Fire S stems Permit <br /> *(traj,, Re) a * 37 ®.w <br /> *Contract Price:$ 1 - *Contract Price: $ <br /> ❑ Residential—Fire Alarm <br /> Fire Stems Permit <br /> * <br /> *Contract Price: $ <br /> tt � eClr«. .,.' 4e t itw6i-„a prIcah4441 i if u t t,';'D 1`4v.2 tb 1''f <br /> A' t. <br /> I herby apply for a Fire Alaini/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 work will be in accordance with the approved plan. <br /> 1 11,E si3a0/0 <br /> Applicant Date <br />