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� �� o � C���m o <br /> . ��s� l-�-e.!l.e P�� C�'-���-,�- ��-y s s 3�3 <br /> � � 7 <br /> ���������������� F <br /> . _ _ <br /> . ao�s-� � � ;-� e� �s <br /> :�: . : .. .. ._.� <br /> �c���: : � v� c�ra�"d <br /> ❑ New Addition ❑ Remodel ❑ Replace <br /> : ,. <br /> Jt�b�����t�Gi.�. - <br /> Iw � 0��-►� �YI��� � <br /> Site Address: ��� �r�6��� � � �� <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Co��r�:�p��e�oB'f. <br /> sP�-vr �F� �r �A'K� <br /> C�ntract�r/Arr.. C P�Q C�ntact rers�n: <br /> Address: J�v T�Yl�I���� � rU�' State License#: �� � � <br /> City: Wa Zip: ��I Expiration Date: <br /> � � �.----� <br /> Phone: � J`�a — �'J' a(--�� Alternate Phone: <br /> _ , _. _ . . , <br /> , .. � -_ <br /> '�!�,�`���-.�?l�#`����fi'�1�� ; " <br /> Commercial—Fire Sprinkler �_Residential—Fire Sprinkler <br /> Fire Systems Permit Fire Systems Permit <br /> *Base Price=Contract Price:$ �T����O a.0125 =S / •b� (Minimnm SSA,00) <br /> *Surcharge�Contract Price:$ �Y� 0��� :.0005 =$ - � <br /> *Mail-In Fee(Only On Mail In Applications) _$ 2.00 <br /> *Totsl Cost of Permit: =S � � ' <br /> The undersigned herby applies to the City far 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,M' esota S te Fire Code and Standards,and certifies that all statements made on this <br /> application are lete,tru and correct. � <br /> I�/ ��3 6 - I 5 <br /> Applicant D� RECEIVED <br /> JUL 01 2015 <br /> cmr aF o�allo <br />