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�.} "„x . AUTOIVIATIC FIRESPRINKLER`PERMITS <br /> : Please Cheek One <br /> New ❑ Addition ❑ Remodel ❑ Replace <br /> lob Site l Owner Information <br /> Site Address: Z-o G a w S 5 Ty,& ,A!f 'z�Nl-yk 75 L Q O, <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor'/tAgplicant Infornatioii <br /> Contractor/App.: FI?-'f- f EoTR_e-Tc0 w Contact Person: '3V 41y <br /> 4If39 Nutt i Z 5`w <br /> Address: to® 13 0 k (15 State License#: t -e�o <br /> City: W 0,v ALL Y Zip: 553070 Expiration Date: <br /> Phone: 7`3 G►So- 14 �c, Alternate Phone: S- <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:$ Ate_ x.0125 =$ JI i:5 (Minimum$35.00) <br /> *Surcharge=Contract Price: $ O 0 v x.0005 =$ Y r (Minimum $_ .50) <br /> *Mail-In Fee(Only On Mail In Applications) =$ 1.50 <br /> *Total Cost of Permit: =$ /t'7/ <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 /> 3 - Z7- oma <br /> Applidht y Date <br /> � '4 rR� "4�..G3�'���"'r <br /> Jf '' �t <br /> ' .. r asst Form ,, "' t f/��a irzq� '�j► r P 7 �P <br />