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FIRE ALARM OR KITCHEN EXTIN UISHER PERMITS <br /> Please Check One: <br /> ❑ New ❑ Addition ❑ Remodel Replace <br /> r Info qo , ' l L 1 <br /> Site Address: a w s W 0. �T l�� <br /> (�� - ('001 Cay, Sf�v1 <br /> Owner: k%(\S ,1�U� l V'" '�Mailing Address: / <br /> City: 6C)Ao Zip: 9+k CA <br /> Home Phone: 1572-- _(llct " 5:75�5— Alternate Phone: lU 2 q <br /> Contractor/A _ licant Information.; <br /> Contractor/App.: -A'Pmor sec"-k(4 Contact Person: 1 V 1 ca, Ro L <br /> Address: vt b"I State License#: <br /> City: yVl Zip: ��" Expiration Date: <br /> Phone: (012--SW -'`/�7 2 Alternate Phone: t0�Z'-t L �- 157�- <br /> VPES OF FIRE PERMITS <br /> Commercial—Fire Alarm ❑ Commercial—Fire Extinguisher <br /> Fire Systems Permit Fire S s�rmit <br /> *(ter UI <br /> *Contract Price:$-31 -7 * *Contract Price: S <br /> ❑ Residential—Fire Alarm <br /> Fire Systems Permit <br /> * <br /> *Contract Price:$ <br /> 'we: Permits are calculated ' <br /> permit. <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 /> N nal Fire Protection Association (NFPA) 72 and 72E, 1996 edition, National Electrical Code and <br /> manu cturers requirements at I understand this is not a permit and work i not to start without a permit; <br /> and t e work will ac or a with the approved plan. ql <br /> Ap licant Date <br /> JR, N � <br /> 413Lo✓e_c/ / <br /> an , <br /> �. ! <br /> 4,12, y04-533t� <br />