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. �' FIRE ALARM OR KITCHEN EXTINQUISHER PERN�CY'TS �� <br /> Piease Check One: <br /> r ❑ New � Addition ❑ Remodel <br /> ❑ Replace <br /> Job Site/Owner Informatiot�: <br /> Site Address: �lQ� ����` SI�� �;'_ <br /> Owner: �}��� ��-c, � Mailing Address: oZ1`�� /�r��r(n �;!'� ��; <br /> City: _� �c ciilG Zip: S.S S'S-� <br /> Home Phone: '���--�7�" 3lQ 7 Alternate Phone: <br /> Contractor/Applicant Information: <br /> /�'1`l�'ft���:-� <br /> Contractor/App.:.:�'n f�vr�.•l�'�r� ��rc_rr�:t�'c� Contact Person: �f� ����i�x�v� <br /> Address: s'rl � �'h�� � 5. State License#: � 05� -3'��/ <br /> City: Si�t4:.5 f�:/� Zip: ��Y�--� Expiration Date: -� � `�`3 <br /> � <br /> Phone: 5�-�y�G �'fi�c:c� Alternate Phone: �.i.�- 7c<�-�3r z <br /> TYPES OF FIRE PERMITS <br /> � Commercial-Fire Alarm ❑ Commercial-Fire Extinguisher <br /> Fire Systems Permit Fire Systems Permit <br /> *(Per UBC) .k'.. *(Per UBC) <br /> *Contract Price: $7 S�XJ.^ *Contract Price:$ <br /> ❑ Residential-Fire Alarm <br /> Fire Systems Permit <br /> *(Per UBG� <br /> *Contract Price:$ <br /> *Note: PermiLc are calculated with UBC Fa Schedule;submit appiication and we��you with a total fee for tlu <br /> permit. <br /> I herby apply for a Fire Alarm/Extinguisher Permit and I acknowledge that the informar�on above is complete <br /> and accurate;that the work will be in conformance with the Ordinances and Codes required by Minnesata <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 /> c��� � �������.ti` �, <br /> Appl icant Date <br /> Reset Form �9P t✓'"v�CI ��� 2 � 0 6 <br /> �,��..:, 'l-vt�..� <br />