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`AUTOMATIC FIRE SPRINKLER PERMITS <br /> iia �l9 <br /> Please,Check One <br /> New ❑ Addition ❑ Remodel ❑ Replace <br /> Job Srte/'Owner;Informatiori: <br /> Site Address: Zof,o wGIST w►arl-e167-k r3�- v0, %3c.0V IL3 5cANrvc- 300 '� 3�� <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> .Contractor./;Applicant Information: <br /> Contractor/App.: vsN� rjgf. Z_ 104Tfi-CTto ,Contact Person: Zry"*,-v WfFAM41- <br /> yy3q S,w <br /> Address: Ao &x (v9 State License#: C -00 1 <br /> City: WjkvrC.1X Y MA" Zip: s s3 g V Expiration Date: (o-3 u -o� <br /> Phone: ?V 3 - (o S 8 f 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 /> ., y- zr-og <br /> Applica Date <br /> { ' wReset Form <br />