Fire Safety Application FIRE SAFETY APPLICATION Date Received:
,lbertvi l le Date Notified
SnoC Pn ro 11Wng.09 Ckv ut. 5959 Main Avenue NE Date Paid
Albertville, MN 55301 Ck, Cash, CC
Phone: 763.497.3384 Fax 763.497.3210 Permit #
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Site Address: BUILDING PERMIT FEES
Business Name: I Permit
The Applicant is: Owner Contractor Tenant
Legal Description:PID# Surcharge
Addition Lot Block
Owner: I Plan Check
Name Address
TOTAL
City State Zip
Email i Received By
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Phone (H) (W) (C)
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Contractor:
I Company Name License#
Type of Const.
Address City St Zip
Occupancy Group
Contact Person Email
Phone: (W) (C) (Fax) Total Sq Ft of Bldg
No. of Stories
Architect:
Name Address
I I Zoning
City State Zip
Max Occupant Load
E-Mail
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Phone (W) (C) (Fax) I Are Fire Sprinklers Required?
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Type of Work:
ElNew R Addition Alteration Demo I L]Yes L]No
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Description of Work:
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Approved by Building Official:
Estimated Valuation of Work: $
Separate perinits are required for electrical,phunbing,heating or fireplace. I herebv apply for the above consideration and declare
that the inforinalion and rnalerials suhrnated with this application are in compliance with City Ordinance and Policv Require- I Date:
rrtents and are complete and accto'ate to the best of my knowledge. It is applicants responsibility to locate and establish the
elevations,if needed,of all site improvements. Required adjustments at owners expense. I understand that all City incurred
professional fees and expenses associated with the processing of this request are the r csponsibility of the property owner and/or
applicant and will be promptly paid. Ifpaymeni is not received from the applicant,the property owner acknowledges and agrees
to be responsible.
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Applicants Signature Applicants Printed Name Date
Special Conditions or Comments: