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AUTOMATIC FIRE SPRINKLER PERMITS , '- <br /> Please Check One: <br /> �] New ❑ Addition ❑ Remodel ❑ Replace <br /> Job Site / Owner Information: <br /> Site Address: 3�i�5 Si�,;-c�.,�2 ,>tt�u� <br /> Owner: ,` �,�,;;-_��,,�� �., Mailing Address: <br /> City: �,�E,,.� Zip: �S 3�] <br /> Home Phone: L� �� - y�n "�j 1 (n� Alternate Phone: �15�'��� �-�`� <br /> Contractor/Applicant Information: <br /> Contractor/App.: ��.�'.w;�� ���2�r���:k��-Y, Contact Person: �e{ �t��.,;1-e <br /> Address: �i�t� ��' �+ � State License #: S' - t�l,f <br /> City: � Zip: — d� Expiration Date: Co-�t�-� aolS <br /> Phone: („�a � a��l -l(c�{3 Alternate Phone: ���- 7.575 -S?al <br /> TYPES OF FIRE SPRINKI.ER PERMITS <br /> Q Commercial—Fire Sprinkler ❑ Residential—Fire Sprinkler <br /> Fire Systems Pertnit Fire Systems Permit <br /> �_ <br /> * Base Price=Contract Price: $�(�Q x.0125 =$ `'��� , Z5 (Minimum$50.00) <br /> 00 <br /> * Surcharge=Contract Price: $�'��Q�— x .0005 =$ � 7. ZS <br /> * Mail-In Fee(Only On Mail In Applications) _$ � �� <br /> Cj�t U''�' <br /> * Total Cost of Permit: _$ �-� �y� , ' � <br /> � �`� <br /> v 1 <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 /> �:.��1�.�� �,��a�aols <br /> Applicant Date <br />