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r <br /> AUTOMATIC FIRE SPRINKLERPERMITS <br /> ® New ❑ Addition ❑ Remodel ❑ Replace <br /> Job Site/Owner'-Tnformatiori. <br /> Site Address: Z o G.0 W R ST Asa A X Al—(k Ay D <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Gontracfor/Applicant Information; <br /> Contractor/App.: FI w Contact Person: 4" wo <br /> ,4'f30, Nw`Y 2 $;cv <br /> Address: o G e k G`i State License#: <br /> City: W pV omit-Lr' Zip: S 3g C7 Expiration Date: _.3 a <br /> Phone: 7�3 C•SI 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: $ 990 0 v, G x.0125 =$ /1 7-5 (Minimum$35.00) <br /> c, <br /> *Surcharge=Contract Price:$ U 0 U 4�) x.0005 =$ til (Minimum $ .50) <br /> *Mail-In Fee(Only On Mail In Applications) =$ 1.50 <br /> U <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 /> 3 -Z7- oma <br /> Appli t Date <br /> y Reset <br />