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� ����- �-v�9 <br /> AUTOMATIC FIRE SPRINKLER PERMITS �`�=' <br /> � �-.����'-(t%� <br /> Please Check One: RECEIVED <br /> �] New ❑ Addition ❑ Remodel ❑ Replace �� ��� ���� <br /> Backflow Device: ❑ AVB �]C PVB <br /> Job Site/Owner Information: <br /> �1�1`�Z�2F'�'D�i4�l,Q <br /> Site Address: � J � .���� 5 ��• Z . � . � `� <br /> Owner: 51-����. +3�'y 1� � r ;, � �-�.' L� <br /> Mailing Address: I �I Y" � - � <br /> City: ��y ���..� Zip: S.5 ��� <br /> Home Phone: Alternate Phone: (,� 7� �3�3' `� �`' � <br /> Contractor/Applicant Information: <br /> Contractor/App.: t,�s �� s• �- �`�'�,� Contact Person: 1�`1� �� t�• j �� � <br /> Address: y►�y I''�r:K<-�z� t L< �c State License#: ��'`� o l. ��- 3�� <br /> City: 5 r �� �h...� Zip: 5 5 3�� Expiration Date: ���`4 <br /> Phone: �1(�� � `� `t�' � �y��� Alternate Phone: (, t � 3�`� - � `� I� <br /> TYPES OF FIRE SPRINKLER PERMITS <br /> ❑ Commercial—Fire Sprinkler � Residential—Fire Sprinkler <br /> l..�i <br /> Fire Systems Permit Fire Systems Permit t, <br /> � t <br /> r. , VC <br /> *Base Price=Contract Price: $ ��� � x.0125 =$ ��`� (Minimum$50.00) � <br /> *Surcharge=Contract Price: $ x.0005 =$ <br /> s <br /> *Mail-In Fee(Only On Mail In Applications) _$ 2. � <br /> *Total Cost of Permit: _$ �� ' <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 /> C� <br /> ��-- ``�.�, �►���1�� <br /> Applicant Date <br />