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i ! <br /> AUTOMATIC FIRE SPRINKLER PERMITS <br /> Please,Check One'.',:. <br /> New ❑ Addition ❑ Remodel ❑ Replace <br /> Joti Site/Owner�.Information: <br /> Site Address: Z 01,o w1IST 1,.114`e 3-61-N 13 `'7, ���� JIM <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor'/,Applicant Information: <br /> Contractor/App.:6tr jji .Y 'S, 0-4 cI'rotiContact Person: jv w--;, ryff,43 S4 <br /> yy3q ►4 �- , z 5,w <br /> Address: Ao Gy&: k9 State License#: -a 1 <br /> City: mri Zip: s 6313 V Expiration Date: !o-3 a -o <br /> Phone: 2(. 3 Co S 4 Lf i� 3 Alternate Phone: <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 /> L/ - Lf—OS <br /> Applica Date <br /> 4 ..r <br /> Reset Form.'; <br />