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f " <br /> a�o9 - ob�s0 <br /> AUTOMATIC FIRE SPRINKLER PERMITS <br /> Please Check One: <br /> ❑ New ❑ Addition � Remodel ❑ Replace <br /> �.� ('c.�c,c� r- <br /> r,� t.,�,►N S � �-r�4,�4 A�,.fL <br /> Job Site / Owner Information: �'r�„�; o,,,, .� �.��f <br /> Site Address: o���"� �� �.0 U <br /> �/�^i�.`�����ir S P rL�-; `CE' �C D��C�'ti"� <br /> V <br /> Owner: ��/Q�CC.0 ��� �Jr� Mailing Address: <br /> City: �V QUQVr� Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor/Applicant Information: <br /> Contractor/A �P�V l� �r-2 �{�OfP��i/1 Contact Person: �� �v(�U'l�i�'S <br /> PP.: <br /> Address: �37��'J o��= �e ��� State License #: �� � l <br /> City: � 1� Zip: 5��� Expiration Date: � � d 9 <br /> Phone: l� 3� �"��UcJ�S Alternate Phone: ' <br /> TYPES OF FIRE SPRINKLER PERMITS <br /> � Commercial—Fire Sprinkler � Residential —Fire Sprinkler <br /> Fire Systems Permit f�ire Systems Permit <br /> * Base Price=Contract Price: $ O Q��� x.0125 =$ � . (Minimum $35.00) <br /> * Surcharge=Contract Price: $ x.0005 =$ • 'rJ d (Minimum $ .50) <br /> * Mail-In Fee(Only On Mail In Applications) _$ 2.00 <br /> * Total Cost of Permit: _$ � � �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 /> application are complete, true and correct. <br /> ��� /��� ���� <br /> Applicant Date <br /> �t ` ' Reset Form <br /> ��,3.-. <br /> ,�,, J/ ,��, f jS�'`� �� /�Cr-- <br /> f f ;/� <br /> t�-�p�o� <br />