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AUTOMATIC FIRE SPRINKLER PERMITS <br /> fl iz/�a <br /> .'Please;Check One <br /> New ❑ Addition ❑ Remodel ❑ Replace <br /> Site/`Owner•;Information: <br /> Site Address: 'zo6 v WISE <br /> W�`r z�� a� v� '�`�`� V- � 5 Sw ►�. �o� � S So <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> ,'Contractor%Applicant Information: <br /> Contractor/App.:5tN-vYi -Y 610-6- 'ern-LTvv,-.Contact Person: �37vvy,-,? �{-'► `�'tL <br /> �lY 3� ►.a„v� i t 5,t.c� <br /> State License <br /> Address: !40 &;L- 6,9 #: '�'�' 1 <br /> City: M^> Zip: ' S 3 i o Expiration Date: (01- 30 -05 <br /> Phone: ?(-3 - (o 5 6 --f k i5 S Alternate Phone: 7711 <br /> TYPES OF FIRE SPRINKLER PERMITS <br /> i 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 /> t/ - Zf--0 �j <br /> Applica Date <br /> Reset Form <br />