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�,i� d� 0 ronc� <br /> ,��:�, <br /> t ' A//�Z/ <br /> Please Check.O�e ���� ' /��-�7 <br /> : � ��,��. �,: �� ...,.,����,. _ <br /> ❑ New ❑ Addition �] Remodel ❑ Replace <br /> -�„ �j -.� 6.� -`5"�a. <br /> �. .: <br /> ���� �, d� ; . ` <br /> Site Address: o��Y')C'� �'�.4t�.vc�oC� c'b.c� <br /> Owner: �����.��o�re� • Mailing Address: SAm� <br /> Ciry: �CO�.p Zip: <br /> Home Phone: Alternate Phone: <br /> Cantractorl A�. <br /> Summit Fire Protection I� �1�./ <br /> Contractor/App.: Contact Person: �., � ,� � <br /> 575 Minnehaha Ave.W. C-075 <br /> Address: State License#: <br /> St.Paul 55103 6-30-0� <br /> City: Zip: Expiration Date: <br /> �6s1>2si-tsgo <br /> Phone: Alternate Phone: <br /> ��''���`�` '�_`' ' �'�`- �YPES OF=FIR�_SPR���KLER PE�2MITS � ��� <br /> �a=w:��,�m — — — <br /> �Commercial—Fire S�rinkler ❑ Residential—Fire Sprinkler <br /> Fire Systems Permit Fue Systems Pemut <br /> * Base Price=Contract Price: $� g.0125 =$ ��• � (Minimum$35.00) <br /> *Surcharge=Contract Price: $ L � x.0005 =$ � (Minimum $ .50) <br /> *Mail-In Fee(Only On Mail In AppGcations) _$ 1.50 <br /> *Total Cost of Permit: _$ •S� <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�ic"��ion are complete, true and correct. <br /> �1„�(��� -�A :�.ti.>d <br /> `�— s—U-1 <br /> Applicant Date <br /> f l�. �,'�� �'��3' �// �/ \` <br /> 1 <br /> w`�g f�es�t�" �� a � � P v v✓c=e� d <br /> � �.. _ �. , n _ ��� i�,�s-i�-- <br /> !�{i� rv l��,•v c��'7 �f 7� a � i�'� <br />