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.,270//- 171-q° <br /> /D -Z/ -// <br /> AUTOMATIC FIRE SPRINKLER PERMITS <br /> Please Check One: <br /> 1J New ❑ Addition ❑ Remodel ❑ Replace <br /> Job Site/Owner Information: ' 7.- i yz►4T Jj f t,vp <br /> Site Address: Orono Sr. Housing Hwy12 and Luce Line State Trail <br /> KA 4210 west old Shakopee rd <br /> Owner: Mailing Address: <br /> City: Bloomington Zip: 55437 <br /> Home Phone: (952) 881-8166 Alternate Phone: <br /> Contractor/Applicant Information: <br /> Contractor/A Brothers fire protection Contact Person: Shawn Kadelbach <br /> Pp. <br /> Address: 9950 E. Hwy 10 State License#: C-059 <br /> City: Elk River Zip: 55330 Expiration Date: <br /> Phone: (763) 441-2290 Alternate Phone: (763) 241-3574 <br /> TYPES OF FIRE SPRINKLER PERMITS <br /> ❑ Commercial—Fire Sprinkler 0 Residential—Fire Sprinkler <br /> Fire Systems Permit Fire Systems Permit <br /> 95,000.00 1 187.50 <br /> *Base Price=Contract Price: $ x.0125 =$ ' (Minimum$35.00) <br /> *Surcharge=Contract Price: $ 95,000.00 x.0005 =$ 47.50 <br /> *Mail-In Fee(Only On Mail In Applications) =$ 2.00cA.eek— ")/ 0 0 <br /> *Total Cost of Permit: =$ 1 237.00 dizeuveA. C-e#1.te, <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 /> applic. '. _,true and correct. <br /> Applicant Date <br /> Reset Form <br />