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Fire Alarm Permit Application

2. Permit Number

4. Site Address

6. City

7. State

8. Zip

10. Owner First Name

11. Owner Last Name

13. Address1

15. Address2

17. City

18. State

19. Zip

21. Tenant First Name

22. Tenant Last Name

26. Contractor

28. Contact Person

29. Phone Number

31. Address1

33. Address2

35. City

36. State

37. Zip

41. Job Valuation

43. Notes

47. Type of Work Being Done

    1. Addition
    2. Alteration

    1. New
    2. Repair / Replace

49. Brief Description of Work Being Done

51. Location in Building

53. Please Check All That Apply

    1. Fire Alarm
    2. Special Suppression System
    3. Other

54. If Other, Specify

56. Fees must be paid, plans approved and a permit issued prior to beginning any work.

    Fees must be paid, plans approved and a permit issued prior to beginning any work.

58. The undersigned states the information provided is accurate and hereby agrees to do all work in accordance with the City Code and the Minnesota State Laws regulating fire alarm systems.

    The undersigned states the information provided is accurate and hereby agrees to do all work in accordance with the City Code and the Minnesota State Laws regulating fire alarm systems.

60. Signature

61. Date
    Date

63. Print Name

65. Incomplete applications will be returned

    Incomplete applications will be returned

66. 24 hour notice for all inspections Call: 763-479-1720 - 7:30 a.m. through 4:30 p.m.

    24 hour notice for all inspections Call: 763-479-1720 - 7:30 a.m. through 4:30 p.m.

67. Permit expires after 180 days without inspections

    Permit expires after 180 days without inspections

71. Occupancy Group

72. Type of Construction

74. Permit Fee

75. Plan Review Fee

    65% of Permit Fee

77. State Surcharge

    Value x 0.0005 (or $0.50, whichever is greater)

78. Total Permit Fee

80. Approved By

82. Title

83. Date
    Date

85. This is to certify that the above application and accompanying documents are in accordance with the community Zoning Ordinance and may proceed as requested. This document when signed by authorized personnel constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of of Occupancy must be issued.

    This is to certify that the above application and accompanying documents are in accordance with the community Zoning Ordinance and may proceed as requested. This document when signed by authorized personnel constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of of Occupancy must be issued.

87. Administrator / Clerk / Planner / Zoning Administrator

88. Date
    Date

90. Special Conditions

Leave This Blank:


91. Print Only

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