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r <br /> W d N <br /> 7 <br /> ❑ New ❑ Addition [ , Remodel ❑ Replace <br /> Backflow Device: ❑ AVB PVB <br /> boli Site/Owner TriformaIon <br /> OWN <br /> Site Address: Z(v� rE..-C, <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> pp• . . .. <br /> Address: -1 �'��� �� State License <br /> City: Zip: 13 Expiration Date: 1UtJL � <br /> Phone: (012. 0 - A-l0 0 Alternate Phone: <br /> N Commercial—Fire Sprinkler F] Residential—Fire Sprinkler <br /> Fire Systems Permit Fire Systems Permit <br /> * Base Price=Contract Price: $ O x.0125 =$ (tVhn�mum$5100 <br /> 29 <br /> * Surcharge=Contract Price: $ x.0005 =$ c <br /> * Mail-In Fee(Only On Mail In Applications) =S. 2.00 <br /> 2� <br /> * Total Cost of Permit: =$ <br /> ADD I - N IAF— 0�1�• 70 2 <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 /> Applicant Dit ...... <br />