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� r � <br /> . �"dllv—� �j'�j'' <br /> � AUTOMATIC FIRE SPRINKLER PERMITS �_ ���i��1�� <br /> Please Check One: RECEIVED <br /> � New ❑ Addition ❑ Remodel ❑ Replace MAY Q 2 z016 <br /> Backflow Device: ❑ AVB �� PVB <br /> Job Site/Owner Information: C1TY OF ORONO <br /> Site Address: � '=�"� ,,�;,�.� a � � � C . =' � <br /> Owner: �}���� �°'� Mailing Address: 1`I y 7 c% �<'��� �� � "' <br /> City: �r����.. Zip: .S 5 3 a, <br /> Home Phone: Alternate Phone: (v ��� j� 3 - `��� �� � <br /> Contractor/Applicant Information: <br /> Contractor/App.: I���:. :� � ��`',� Contact Person: � �`� �4 ;- > <br /> Address: �i t�� r��,-�'�=z -: � � � State License#: �� u i, �-:� ) � <br /> City: �r i"�;��..,' Zip: `���>' ,'" Expiration Date: ��� i � <br /> Phone: 7(�� �I`,� �'� � " Alternate Phone: (�t) - .3���- �t `i i � <br /> TYPES OF FIRE SPRINKLER PERMITS <br /> ❑ Commercial—Fire Sprinkler � Residential—Fire S np �nkler <br /> , <br /> Fire Systems Permit �7 Fire Systems Permit <br /> � <br /> � ��` � C�� <br /> *Base Price=Contract Price: $ ZE��\� x.0125 =$ l!% � (Minimum$50.00) <br /> *Surcharge=Contract Price: $ x.0005 =$ <br /> *Mail-In Fee(Only On Mail In Applications) _$ . 0 <br /> � � � <br /> *Total Cost of Permit: _$ ( ! L� ' <br /> The undersigned herby applies to the City for issuance of a Sprinkler Systems Pernut. Applicant agrees <br /> that all systems shall be designed, installed and maintained to N.F.P.A.-13,N.F.P.A.-25, Minnesota State <br /> Building Code, Minnesota State Fire Code and Standards, and certifies that all statements made on this <br /> application are complete, true and correct. <br /> ��•�.--L._._--..�-�,��—. '-1'�7'� � <br /> Applicant Date <br />