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` RECEIVED <br /> MAY 31 2016 <br /> FIRE ALARM OR KITCHEN EXTINQISHER PERMITS <br /> CITY Or OR NO <br /> buL j‘ <br /> AP <br /> Please Check One: � . <br /> 7/ 7 <br /> ❑ New Xl. Addition ❑ Remodel ❑ Replace <br /> Job Site/Owner Information: <br /> Site Address: IBO 0 Old C S1 Raj Rd N <br /> Owner: O rOhO M IddIP Sa)00 ( Mailing Address: <br /> City: 1'1 LO K Q, Zip: 5 53 5(p <br /> Home Phone: q 9Q-•.J1'H 9 -2)4s0 Alternate Phone: <br /> Contractor/Applicant Information: <br /> Contractor/App.: i_oW V o (tQ9Q C0flhTQCtactrs <br /> Person: ba,no RIa S - <br /> Address: 4cApO \ 4 QSt 7(o th St. State License#: fscioo 3-1'' <br /> City: 1,AInneapoil Zip: 55tf 3 5 Expiration Date: 7 -31- 1 (0 <br /> Phone: GI 53- 5 I(.o-lQ O-I"I Alternate Phone: q ga-a9 a"a R D(p <br /> TYPES OF FIRE PERMITS <br /> X1 Commercial—Fire Alarm ❑ Commercial—Fire Extinguisher <br /> Fire S stems Permit1' r- rr�� Fire S stems Permit <br /> x%Co Price: $ 47, (oOO. V *Contract Price: $ <br /> ❑ Residential—Fire Alarm <br /> Fire SS stems Permit <br /> *Contract Price: $ <br /> *Note: Permits are calculated with UBC Fee Schedule;submit application and we will call vo ` <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 /> Nation. Fire Protection Association (NFPA) 72 and 72E, 1996 edition, National Electrical Code and <br /> manuf. turers requirements;that I understand this is not a permit and work is not to start without a permit; <br /> and :t the wo /wi 1 be in accordance with the approved plan. <br /> /.LA— AOI/. iI 5 —o;Co —1(.o <br /> Applicant ' Date <br />