Laserfiche WebLink
FIRE'SPRNKLEItilE11-, <br /> I 1--1 ) rL*-'1 \f.) 4'5 ' ;V•-•,v-.: `t..) <br /> 4 cv• •• • <br /> 7 New n Addition Remodel Replace <br /> Job Information -- - <br /> Site Address: 7_0C,IO1.)--I . k <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone:Cc)44-t,1-1-. -/-7c.),ic)(, lternate Phone: (0\7- - <br /> s-Ce.v4)gL r <br /> ( C e <br /> Contractor/App.: °L.-to- Ir--1 Contact Person: 1,, ) <br /> Address: '' State License#: CLO <br /> City: Zip: - - - Expiration Date: -1 - <br /> Phone: L, 71, Alternate Phone: <br /> TES OFF -PlEZINFICLER PERMITS- <br /> 111 Commercial—Fire Sprinkler [1 Residential—Fire Sprinkler <br /> Fire Systems Permit Fire Systems Permit <br /> *Base Price=Contract Price: $ x.0125 =$ 1 . i (Minimum$35.00) <br /> *Surcharge=Contract Price: $ • x.0005 =$ (Minimum $ .50) <br /> ;CO- C— \Cc.,r( <br /> *Mail-In Fee(Only On Mail In Applications) =$ 1.50 Nr--- <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 /> CT) <br /> Applicant D . Date <br /> Keset <br />