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}"'*" � <br /> AUTOMATIC FIRE SPRINKLER PERMITS <br /> Please Check One: <br /> ❑ New ❑ Addition �] Remodel ❑ Replace <br /> � <br /> Job Site/Owner Information: <br /> Site Address: ��G� 5�p,d v wooc�.. ��o�c�. <br /> Owner: ���,Si��t--,r'�,��� Mailing Address: �_ <br /> City: ���C] Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor/Applicant Information: <br /> Contractor/App.: � ` Contact Person: �.a�- V 1`(� <br /> Address: ��_����,P�nc.��./�v re _�State License#: (���-� <br /> City: Zip: SS/Q3 Expiration Date: (p 3D--U� <br /> Phone: �S l�a--S I— 1��.> Alternate Phone: <br /> TYPES OF FIRE SPRINKLER PERMITS <br /> �, Commercial—Fire Sprinkler ❑ Residential—Fire Sprinkler <br /> Fire Systems Permit Fire Systems Permit <br /> *Base Price=Contract Price: $� x.0125 =$ - Sd (Minimum$35.00) <br /> * Surcharge=Contract Price:$ ��� x.0005 =$ � • S d (Minimum $ .50) <br /> * Mail-In Fee(Only On Mail In Applications) _$ 1.50 <br /> *Total Cost of Permit: _$ � <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 /> appli ti n are co pl te rue and correct. <br /> � ���� <br /> Applicant Date <br /> Reset Form <br /> il <br />