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ol <br /> i4w, p, ,.' AUTOIVIATICFIRE`SPRINKLERPERMITS '`` <br /> F X' Y'1.rA� '�i ... <br /> 3-3-0 <br /> Please' lieck C?ne <br /> New ❑ Addition ❑ Remodel ❑ Replace <br /> Joli Site��w'nier,Informatiori ,'' '=; -�;-` <br /> Site Address: &o G o W F:'.ST W A N-M t3 L v O <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor/App.: Fi JL.E P#-o'tsr-: c:r% ►v Contact Person: 7v 4" w fE'Q <br /> Address: eq 0 0). L`i State License#: <br /> City: w py LV Zip: 55 3g 0 Expiration Date: 4o -30 O o <br /> Phone: 9(►3 -!•So- I Alternate Phone: <br /> SM'FIRE,S W'NI{LER PEAWT5 <br /> Commercial—Fire Sprinkler ❑ Residential—Fire Sprinkler <br /> Fire Systems Permit Fire Systems Permit <br /> *Base Price=Contract Price:$ 90�_ x.0125 =$ /1 CS a� (Minimum$35.00) <br /> i <br /> *Surcharge=Contract Price:$ n 0 o J x.0005 =$ Y z (Minimum $_ .50) <br /> *Mail-In Fee(Only On Mail In Applications) =$ 1.50 <br /> U <br /> *Total Cost of Permit: =$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 - Z7- vim <br /> Applit Date <br /> t ,�,r r <br />