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° AUTOMATIC FIRE SPRINKLER PERMITS <br /> Please,Check One <br /> ®. New D Addition ❑ Remodel ❑ Replace <br /> Job Site/Owner:Information: <br /> Site Address: Ze,(,o Loa S T w rk-1-c ate. LVO %ILO 6-'0t Z 5k4 zt,o 4-?.;5-0 <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor"Applicant Information: <br /> Contractor/App.:S i'C'44 11j2-1t fQQTtTtv'ontact Person: ►4t) Vv 3,z rZ <br /> 3 9 t-tu.•( ) Z s,w <br /> Address: 9u 6::,x 1,9 State License#: C —arca 1 <br /> City: iA4Nv N'i'v Zip: 5.5-39 v Expiration Date: - 3o `" g <br /> Phone: 7 V 3 --to - `J Lig 3 _ Alternate Phone: (on <br /> TYPES OF FIRE SPRINKLER PERMITS <br /> Commercial—Fire Sprinkler ❑ Residential—Fire Sprinkler <br /> Fire Systems Permit Fire Systems Permit <br /> *Base Price=Contract Price: $ x.0125 =5; (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 /> application are complete,true and correct. <br /> L1 —a , <br /> Applica / Date <br /> • Reset Form <br />