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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.
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.
60. Signature
61. Date
    Date
63. Print Name
65. 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.
67. 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.
87. Administrator / Clerk / Planner / Zoning Administrator
88. Date
    Date
90. Special Conditions
Leave This Blank:


91. Print Only

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