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AUTOMATIC FIRE SPRINKLER PERMITS <br /> 1 <br /> Please Check One: <br /> ❑ New ❑ Addition 4' Remodel ❑ Replace <br /> Job Site/Owner Information:W ,, A <br /> Site Address: u -1 <br /> Owner: MAI A 1 L Mailing Address: P 'T (A 12 <br /> City: a v. 0 Zip: 5S <br /> Home Phone: Qs-2 3'- Alternate Phone: <br /> Contractor/Applicant Information: f <br /> Contractor/App.:�� t tS ' Contact Person: -C _ CELIS—e. ,/ <br /> Address: q( Z f/1S r Hu.) <br /> /0 State License#: Cot) S <br /> City: 1l'41'14.-4 Zip: `" �? Expiration Date: <br /> Phone: 46;3--44 t ' 22Pr 6 Alternate Phone: 7 t - ' 2. 'Ic-6 <br /> TYPES OF FIRE SPRINKLER PERMITS <br /> commercial-Fire Sprinkler 0 Residential-Fire Sprinkler <br /> Fire Systems Permit Fire Systems Permit <br /> ✓ i� <br /> *Base Price=Contract Price:$ Ctx.0125 =$ 10 gam"' (Minimum$50.00) <br /> *Surcharge=Contract Price:$ `t(V) x.0005 =$ <br /> *Mail-In Fee(Only On Mail In Applications) =$ 2.00 <br /> *Total Cost of Permit: _$ � <br /> (ll‘,0Q1103 SonN -rd $Amu._ A /Wwbt?c <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 /> Applicant Date <br />