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M SYSTEM RECORD OF COMPLETION 2013 E E To be completed by the system installation contractor at the time of system acceptance a ap 21 2023 -J Form Completion Date: 2./1`f,l /0O Z 3 MARION COUNTY 1. PROPERTY INFORMATION/�I` t� 1 ""� f BUILDING�7 INSPECTION-gyp Name of property: CK ST0-4-es A (-I�men�5 �jSS- 2-o t oo 5ta -S"` Address: g72. N Second S reet 555 -ZZ-- Okoc51 -stR Description of property: Cj — ZZ — Ot c4 58 —STR Name of property representative: j3�j — Z2 —CJ1 bo 59—STIZ Address: 5 —ZZ'(DlC0 l.00—Sig. Phone: Fax: E-mail: `j`j�j—22.— OtDC1( 2. INSTALLATION, SERVICE, TESTING, AND MONITORING INFORMATION 5c-s'2Z — 0113062 Z Installation contractor: PraceSS Ir)Inai Securi'fy , \a,rwi S°'me Address: \NO Fesc,ve St SE Sui+e A At c y, pz cor g7322 all 5W1-96�.-BII�! (' Phone: Fax: Email: eSal0 peak . or9 Service organization: t Address: Phone: Fax: E-mail: Testing organization: Address: Phone: Fax: E-mail: Effective date for test and inspection contract: Monitoring organization: Address: Phone: IIJJ LL 1 Fax: E-mail: Account number: Li6- 38S1 Phone line 1: all Phone line 2: cell Means of transmission: Cet I ve i Zo r1 Entity to which alarms arc retransmitted: Phone: 3. DOCUMENTATION On-site location of the required record documents and site-specific document box software: FALt p 4. DESCRIPTION OF SYSTEM OR SERVICE This is a: Is)New system ❑Modification to existing system Permit number: NFPA 72 edition: 4.1 Control Unit Manufacturer: S I 1{Y1 klnl�tn1 Model number: SK `" 6700 4.2 Software and Firmware Firmware revision number: 4.3 Alarm Verification rg This system does not incorporate alarm verification. Number oldevices subject to alarm verification: Alarm verification set for seconds • Copyright 02018 Automatic Fire Nam Association Phone:844-i38.2322 w w.ataa.org 1 of 3