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A ,� <br /> FIRE ALARM OR KITCHEN EXTINQUISHER PERMI <br /> Please Check• <br /> * ke <br /> n New Addition ❑ Remodel a Replace <br /> Mute..2A\1 <br /> Job Site/Owner Informatt'irt: ,nn <br /> Site Address: IO -5 C'MS \ t„� <br /> Owner: Ofpno t. ltV>� Mailing Address: YkYruz- IOZrj CO Cr,S}GI r ' <br /> City: OCOn0 Zip: 55 3Z 3 <br /> Home Phone:(55?) 1L( - 6090 r6hcv>\ o'Alternate Phone: (1q 0:5-7 - 7`15-1 <br /> Contractor/App.: Contact Person: re.6.)14TS��,. <br /> Address: G`-6700 Ele_c_k(: ' State License#: TS Ob2Z r <br /> City: Zip: 55 313 Expiration Date: 1-2 1 `c.O <br /> Phone: to nckea.,J ( JI`2R Alternate Phone: (76 J`-rn -33% <br /> ® Commercial—Fire Alarm ❑ Commercial—Fire Extinguisher <br /> Fire S stems Fire S stems Permit <br /> *Contract Price: $ ) 0 *Contract Price:$ <br /> ❑ Resident��iall—Fire Alarm <br /> Fire SS stems <br /> Permit <br /> ,r <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 <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 /> `Applicant Date <br />