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Nov 1f 2001 2:58PM No-8832 P.`41;/4 <br /> - °` STAVE OF MINNESOTA <br /> DEPARTIIIENT OF PUBLIC SAFETY <br /> STATE FIRE MARSRAL DIVISION <br /> 444 Cedar Street,Suite 145*St.Paul,MN 55101-5I45 <br /> Phone:6511215-0500}Fax:651/215-0525 *TTY:651/282-6555 <br /> APPLICATION FOR VARIANCE/TIlWE EXTENSION <br /> Dear State Fire Marshal: <br /> Please accept this application for the following matter. <br /> Variance "Time Extension <br /> Name: Ep- an- .fin.c. Phone: (f) Z173- 113 SIV <br /> ;Address' 26 8 !,t f. Gc� /31 c�0./. Fax: (�� - 4 3 <br /> City:_ QKO»p State: MA/ Zip: 55 35(0 <br /> iA E-Mail Address: SJOCh,mS C-' a0/ Com <br /> Relationship to Property:_Owner _Manager _Agent _Other: AA a r` <br /> Property Name: .e/y7` ?. �bL,. .;y►.�y(G, Phone: (2L*2= S/73- V35r� <br /> Address: 24o,?7 W. lALl Za i Q1 vo( Fax: ( 9SZ) _4 `73 — �l3 3 z <br /> City: ©aceto MN Zip: 55 354 File#(if known): <br /> Fire Inspector Name: Item number(s): Compliance date: <br /> (time extensions only) <br /> Date of Order: Item 1: Description of violation/issue: <br /> rs <br /> VS. eS5e) 6e&//071- s <br /> Inf rmation Provided(check all that apply): <br /> VS Governing Body Body Action(opinion from City Council,Board of Appeals,County Board,Township Board) <br /> photographs <br /> ...j4loor Plans/Diagrams <br /> _Contractor Bids <br /> _Plan of Correction <br /> _Otho: <br /> Signature of Requestor: Date. /2/6 Z.2 <br /> For variance requests,please attach a complete statement explaining items A,B,and C from page one of the <br /> instructions. For time extension requests,please attach a statement explaining items I,IL and III from.page two <br /> of the instructions. <br /> Supplemental items such as floor plans,contractor bids or photographs are encouraged <br />