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inatAi /303A coq- eao4/0Z.; <br /> ❑ New 1541 Addition ❑ Remodel n Replace <br /> Site Address: 0OO WeST t,da yq,,ciTck Qtua <br /> Owner: Wc%yZQkA CoyAtr/ cLo Mailing Address: A0 LJ. (oaf*Ara 13(vc, <br /> City: k•f4,,A'1' Zip: 55 39 1 <br /> Home Phone: 15 a-I-113 -11.4644, Alternate Phone: <br /> Contractor/App.: Sim hn tT Fife Contact Person: Sco1T'5e,Ad f <br /> Address: 511 144eha ktc Ave 1)• State License#: C O 11— <br /> City: <br /> City: StPA:44 A Zip: 55103 Expiration Date: 0./71 /c,' <br /> Phone: CV- aC i-i 8430 Alternate Phone: <br /> 5(1 Commercial—Fire Sprinkler ❑ Residential—Fire Sprinkler <br /> Fire Systems Permit p Fire Systems Permitit <br /> *Base Price=Contract Price:$ (J� `00 x.0125 =$ 141.0).45-- <br /> '7 Tc),"��j <br /> (Minimum$35.00) <br /> *Surcharge=Contract Price:$ 11,q OO x.0005 =$ CIS (Minimum $ .50) <br /> *Mail-In Fee(Only On Mail In Applications) =$ 1.50 <br /> *Total Cost of Permit: =$ 1 5p.ao <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 /> 1oi <br /> Applicant Date <br /> l/ottogy J/1 t VAN Cyl/ 3.2.0.1 OP-C) <br />