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New ❑ Addition ❑ Remodel ❑ Replace <br /> Ial'Site/"Owner Inforniatton: <br /> Site Address: <br /> Owner: A*44— g�l"gA'1774 ' Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor/A%p1t��ntT r�fp mations <br /> Contractor/App.41vt-)F/fl Aogeb4oc,4ontact Person: C 5 �0 olz6 e)e <br /> Address: 7Z'5­ D0e4 State License#: 1 ro Z�d <br /> City: Zip: Z�g350 Expiration Date: (/P— �- <br /> Phone: Alternate Phone: <br /> ..TPS.QF FI1t 'SElIIE�t~PE� MI'T5 <br /> Commercial—Fire Sprinkler ❑ Residential—Fire Sprinkler <br /> Fire Systems Permit 'l Fire Systems Permit <br /> *Base Price=Contract Price: x.0125 =$ (Minimum$35.00) <br /> *Surcharge=Contract Price:$ x.0005 =$ (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 /> app ' tion are complete,true and correct. <br /> --3/dv <br /> Applicant Date <br /> °R 0"FQrn� <br /> f�P p two v�q� b 3 0 S <br />