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T>N UISHERPERIMI <br /> New ❑ Addition ❑ Remodel ❑ Replace <br /> MININININSMEM <br /> Site Address: <br /> Owner: Mailing Address: Saw-<— <br /> City: 0Co r,o Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor/App.: l 2 kn n Contact Person: Y, v Nkc'W <br /> Address: �a, fr S V�.,�.���� s _ State License#: <br /> City: i Zip: M.. Expiration Date: <br /> L138-�ty gg <br /> Phone: 7 G 3 - Alternate Phone: <br /> ❑ Commercial-Fire Alarm ❑ Commercial-Fire Extinpuisher <br /> Fire S stems Permit Fire S stems Pemut <br /> *Contract Price:$ Contract Price: $ <br /> ❑ Residential-Fire Alarm <br /> Fire Systems Permit <br /> *(Per UBC) <br /> *Contract Price: $ <br /> 0rM=MWMWM==M="WM=MM===== <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 work will be in accordance with the approved plan. <br /> 7- ;3 - t � <br /> Applicant Date <br /> SOMME <br /> W" d <br />