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5 <br /> AUTOMATIC FIRE SPRINKLER PERMITS <br /> /4/2 //‘o. <br /> Please,Check One <br /> g New ❑ Addition n Remodel Replace <br /> Job Site/Owner;Information: <br /> Site Address: LbL a w ST w pc`(Zaco3, t3L J. 6 L ) t'' t 5 K ‘ )0,o <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor'/,Applicant Information: <br /> Contractor/App.:5.6uVA- s I1Z- 11A-virt.cF14cQContact Person: 't+N Wrt i3 <br /> H y r L 5,w <br /> Address: P0 e c x G 9 State License#: C -v,o ( <br /> City: w A Vt'za -' M N Zip: ,3 9 9 Expiration Date: to - o v C' <br /> Phone: 710.3 a ' " f 1 f3 3 Alternate Phone: Con- -91.3--Ir s 3.5 <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 =$ (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 /> Ap . ant 7 Date <br /> Reset Form <br />