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y i�-o� <br /> '� o oco�o i9�o885 ��5. s1� <br /> AUTOMATIC FI�2E���PRIN�LER:PET2NIITS � �:` .��,r.�, , e � ��:� <br /> � <br /> Please'Check One � ^ F" �" '� t . `: : <br /> _�, <br /> ❑ Ne�� ❑ Addition � Remodel ❑ Replace <br /> Job Site/Owner�Infarmation; �, � ���� � _ <br /> Site Address: '�.c�.v � � —��.GX77�rv�_��n� <br /> Owner: �r'��wc�� �`,e�, Mailing Address: �m� <br /> City: Zip: <br /> Home Phone: Aiternate Phone: <br /> Cont�actor/�.Applicant Infonnation��:� ;. ,r; <br /> Contractor/A �UMA'1j 1 C'<<�.�ro�"�ti,r�... Contact Person: m,Q:�" ��f�{�.L_ <br /> PP•�� <br /> Address: ��l ��n(�.p�.�r'� State License #: l. 'Q75 <br /> City: l..l (o Zip: '��Y Expiration Date: � — 3� —'�� <br /> Phone: 1Q5�' Z��— �g�d Alternate Phone: <br /> TYP�S OF FIRE`SPRINKLER PERMITS 'i <br /> �] Commercial —Fire Sprinkler ❑ Residential —Fire Sprinkler <br /> Fire Systems Permit Fire Systems Permit <br /> � <br /> * Base Price=Contract Price: $ x.0125 =$ 3S —' (Minimum $35.00) <br /> *cu:e!:arge=Cor.tra�t Pri��:��� x:�0�5 =� • Sv (Minimnr.: $ .�4) <br /> *Mail-In Fee(Only On Mail In Applications) _$ 1.50 <br /> O P.� <br /> *Total Cost of Permit: _$ <br /> ��Cv..-�-� �O �4[3.Cl,p ��U e.w7 G�1�^-o Cl C�i �i riC�_ IA�_ �n Q <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 /> appl' at' n are complete,true and correct. <br /> . � / � <br /> (p-- <br /> Applicant Date � <br /> � � �� Reset Form � / <br /> � i�.�f.f-�.�,�.�� � �� � { �';�� <br /> il <br /> �..�..•��`i�1.. �l i �1'.J <br />