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❑ New ❑ Addition Remodel ❑ Replace <br /> Site Address: / 25Wix LA Z U <br /> Owner: 6L -, Mailing Address: 10 //a2 <br /> City: ge��i� �� Zip: <br /> Home Phone: ` VZ-215--TN-2 Alternate Phone: <br /> AA <br /> Contractor/ApP. Contact Person: <br /> d <br /> Address: 1901 �",rj t State License #: 13C <br /> City: i-c U1 f Zip: Expiration Date: <br /> Phone: — 1 -�6�,6 Alternate Phone: <br /> NEW- <br /> Q 'ER11S <br /> Commercia —Fire Alarm ) ❑ Commercial—Fire Extinguisher <br /> Fire S stems Perm. — — Fire S stems Permit <br /> * p0 * ) <br /> * Contract Price: $ Contract Price: $ <br /> ❑ Residential—Fire Alarm <br /> Fire Systems Permit <br /> * Ma <br /> ) <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 State <br /> 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;and <br /> that the work will be in accord ith the approved plan. <br /> - 4 - 5 - 16 <br /> Applicant Date <br />