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j AUTOMATIC FIRE SPRINKLER PERMITS <br /> Please Check One: <br /> ❑ New ❑ Addition /R� Remodel ❑ Replace <br /> Job Site/Owner Information: <br /> Site Address: <br /> Owner: Mailing Address: <br /> ��v S s 3a <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor/Applicant Information: <br /> Contractor/App.: /5/c)A�'/ :ez, �� onQct Person: ��C!'!✓ �- <br /> Address: /,q State License <br /> City: 't r Zip: Ss� � Expiration Date: (J - <br /> Phone: M7G3 �O 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: $ 4V x.0125 =$ / (Minimum$35.00) <br /> *Surcharge=Contract Price:$ 7 90 (-dg.0005 =$ (Minimum $ .50) <br /> *Mail-In Fee(Only On Mail In Applications) =S 1.50 <br /> *Total Cost of Permit: =$ / /U <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. 16e2 7 <br /> Applicant Date / <br /> Rent Form �f v ew <br />