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AUTOMATIC FIRE SPRINKLER PERMITS <br /> 3-3/-01 <br /> Please,Check One . ';'- , /9//T(/''//9 <br /> g New ❑ Addition ❑ Remodel ❑ Replace <br /> Job Site 1 Owner;Information: <br /> Site Address: Z-o G. o RST w A`e Lk.-7 ° , <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> ;Contractor'/Applicant Information; <br /> S <br /> Contractor/App.: F% w Contact Person: -3-t? w fe-05 v�Z <br /> 4`F3t3 Nut ( iZ 5°(4) <br /> Address: jo r3 e xG.9 State License#: Z- —(.2 o I <br /> City: W A.0 Fez_ I;' Zip: SS 39 C7 Expiration Date: 6 3 c C <br /> Phone: 7`3 L►S , 3 Alternate Phone: (et Z - /G 5- 3 <br /> v . :` TYPES OF FIRE SPRINKLER PERMITS <br /> N' Commercial—Fire Sprinkler ❑ Residential—Fire Sprinkler <br /> Fire Systems Permit Fire Systems Permit <br /> *Base Price=Contract Price: $ 9o,0 P C x.0125 =$ II IS .--- (Minimum$35.00) <br /> c� <br /> *Surcharge=Contract Price: $ o x.0005 =$ Y - (Minimum $ .50) <br /> *Mail-In Fee(Only On Mail In Applications) =$ 1.50 <br /> G <br /> *Total Cost of Permit: =$ /I 71 ----- <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 /> 3 - z 7— a <br /> Appli- nt p]n / Date <br /> r s N,laa • � t R set orrn ,4frp,;a ;r Lc �`jl / /7/©c, <br />