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� � � �o��- ���� <br /> AUTOMATIC FIRE SPRINKLER PERMITS �, � � <br /> ,�. � <br /> i ;�4'; <br /> , v> <br /> Please Check One: RECEIVED <br /> �] New ❑ Addition ❑ Remodel ❑ Replace }�QY (j � ���� <br /> Backflow Device: ❑ AVB � PVB <br /> Job Site/Owner Information: CIN OF ORONO <br /> Site Address: (, '� s � ,��-.; s �� �� � , -=' <br /> Owner: S ��U�,�- �•-y Mailing Address: ►'� �7 p (3,-�� I< ��� - �-�� <br /> City: �),�y ��,� Zip: �j S 3 �� <br /> Home Phone: Alternate Phone: �. �� � �3(;�3- �-��_'" <br /> Contractor/Applicant Information: <br /> Contractor/App.: � ��r �, 5 : � C� �� � Contact Person: i"� (c< Tc , �_� -� <br /> Address: `�i s�`� I�v1�ti�i � �z ,�- �t State License#: �t"� o� �3-�� <br /> 1 <br /> City: � F r�; � �,.,t� Zip: ;� ;:y i t� Expiration Date: �� � I� <br /> Phone: ��i�'�� -��;�! � -� �+ ;� � Alternate Phone: (. �,�1� � ,_�, - � =, < <� <br /> TYPES OF FIRE SPRINKLER PERMITS <br /> ❑ Commercial–Fire Snrinkler �] Residential–Fire Sprinkler <br /> Fire Systems Permit L, Fire Systems Permit <br /> }�7 ���� .- c L <br /> *Base Price=Contract Price:$ � . ?l,'V x.0125 =$ � �' � (Minimum$50.00) <br /> *Surcharge=Contract Price: $ x.0005 =$ <br /> *Mail-In Fee(Only On Mail In Applications) _$ 2.00___,�. <br /> i ✓ <br /> *Total Cost of Permit: _$ �" <br /> �, , <br /> The undersigned herby applies to the City for issuance of a Sprinkler Systems Permit. 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 /> ; <br /> , <br /> � �"� —_ �`��-���, �" <br /> Applicant Date <br />