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AUTOMATIC FIRE SPRINKLER PERMITS <br /> Please Check One: <br /> New ❑ Addition ❑ Remodel ❑ Replace <br /> ackflow Device: ❑ AVI� ❑ PVB <br /> Job Site/Owner Infonnation: <br /> Site Address: 3 S`��o ��.or�e-l�r•.� Or�ve_ <br /> Owner: �� �o�r�,.�-1-� Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor/Applicant I�lformation: <br /> Contractor/App.: 5,�,,,,",,.',� C�a,,h,�5 Contact Person: \��,,� S�.-��,,.5�. <br /> Address: ��"� (��nre,�v,�n� Qve-W State License #: C-�-}S <br /> City: S�'. �r,,,,� Zip: 5'S 1�3� Expiration Date: �0 3� �(o <br /> Phone: �fv5�) 2�2' 3Z� Alternate Phone: ((�S>25� - 1$80 <br /> TYPE5 OF FIRE SPRINKLER PERMITS <br /> �Commcrcial—Fire Sprinkler ❑ Residential—Fire Sprinkler <br /> Firc Systcros Pcrmit Firc Systcros Pcrmit <br /> 00 <br /> *Base Price=Contract Price: $ ��d x.0125 =$ 30 b � (Minimum$50.00) <br /> cs o <br /> * Surcharge=Contract Price: $ 2,� `doa x.0005 =$ �Z '� <br /> *Mail-In Fee(Only On Mail In Applications) _$ 2.00 <br /> 00 <br /> * Total Cost of Permit: _$ �j�� �' <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 /> ap lication are complete, true and correct. <br /> - ��� � <br /> Applicant Date <br />