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2. 
4. Building/Occupancy Name*
6. Address*
7. Email Address*
9. Contact Name*
10. Phone Number (include dashes)*
12. Contractor Company Name*
14. Address*
16. City*
17. State*
18. Zip Code*
20. Contractor Name*
21. Email Address*
22. Phone Number (include dashes)*
24. State License Number*
25. Number of Systems*

    (Permit fee is based on type of system and number of systems installed)

27. Type of Permit*
    -- Select One --Kitchen Fire Suppression System ($150)Special Suppression System ($200)Clean Agent Extinguishing System ($200)
29. Brief Description of Work*
31. Use Type: Residential/Commercial *
    -- Select One --Single (101)Single Attached (102)Two-Family (103)3-4 Family (104)5 or More Family (105)Condo (106)Hotel, Motel (213)Garage, Car Port, Shed (438)Mobile Home (401)Amusement, Recreational (318)Church, Other Religious (319)Industrial (320)Parking Garage (321)Service Station, Repair Garage (322)Hospital, Institutional (323)Office, Bank, Professional (324)Public Utility (325)Schools, Other Educational (326)Stores, Mercantile (327)Other Nonresidential (328)Structure Other Than Buildings (329)
33. Standards Used in Design*

    1. NFPA 96
    2. NFPA 2001
    3. Other NFPA Standards
    4. Other Codes or Standards
34. Edition Used and/or Other Standards Explained *
36. Attach Plans and All Other Supporting Documentation Here*

    PDF files only

    Acceptable characters for file name: A-z 0-9 ~ ! (  ) - + = [ ] { } , . _

38. Agreements/Acknowledgements*

    By Checking this box, I hereby apply for a Commercial Kitchen, Special Suppression, Clean Agent Fire Protection system permit and acknowledge that the information above is complete and accurate. That the work will be done by a licensed, certified and qualified installer in conformance with the applicable NFPA Standard, the Minnesota State Fire Code, Minnesota State Stature, and codes and ordinances adopted by the City of Winona. I understand that this is not a permit but only the application for a permit and work is not to start without a permit. The work shall be in accordance with the approved plan in case of work which requires review and approval of plans.

    I acknowledge that the final acceptance of the system will rely upon the fire department’s onsite coverage inspection and witness to a functional operations test of all components. All accuracy of the installation shall be the ultimate responsibility of the installing contractor.

    I have attached all necessary plans, specifications, and documentations to the permit application in the space provided because I understand that paper copies will no longer be accepted.

    1. I agree.
40. Payment Agreement*

    By Checking this box, I understand that I will receive an invoice sent to the email provided and when I receive this invoice I agree to call and make a payment by phone to the City of Winona finance department at 507-457-8262 in reference to the invoice number and I understand that I will not receive a permit until the invoice is paid in full.

    1. I agree.
42. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
44. Electronic Signature*
Leave This Blank:


46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit

* indicates a required field