Laserfiche WebLink
AUTOMATIC FIRE SPRINKLER PERMITS <br /> Please Check One: <br /> � New ❑ Addition ❑ Remodel ❑ Replace <br /> Job Site/ Owner Infarmation: <br /> Site Address: 2� f�v .Fi1V ' ��� 1� ��3�0� <br /> sv�r.l G��l��so+� 153 1.J�K� S . � . <br /> Owner: �a� Mailing Address: T <br /> Ll <br /> ��ty: ��T� z�p: �539 I <br /> Home Phone: ��2� ��� ���� Alternate Phone: �p�2'� I �2� f� <br /> Contractor/Applicant Information: <br /> R� _ � ��f�ll� �1 WI�R <br /> Contractor/�i.:���.(�IVS�(�� Vl�Contact Person: <br /> ��c ' c � <br /> Address: �2� � I�V�A. . State License#: <br /> City: B��t�L"�� Z�p: 5�40� Expiration Date: � � �� _ <br /> Phone: U��•��� �3���J �k AI.�OCA►I.�hone: �Z '7��'•�i�2(� <br /> TYPES OF FIRE SPRINKLER PERMITS <br /> ❑ Commercial—Fire S�rinkler �Residential—Fire Sprinkler <br /> Fire Systems Permit Fire Systems Permit <br /> r � p <br /> * Base Price=Contract Price: $ ��i��• x A125 =$ � (Minimum $50.00) <br /> � � <br /> *Surcharge=Contract Price: $��x.Q005 =$ `-' � �A'�C!!�i <br /> *Mail-In Fee(Only On Mail In Applications) _� � ���� <br /> *Total Cost of Permit: _$ <br /> 2�a."_ ��� <br /> '�}i�5 W►�� 8� �1 I��A �3 � �t���� 5��1 . <br /> _ The undersigned herby applies to the Ciry 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 /> applicaf e comp te,true a ct. - <br /> � �� �� <br /> Appl icant Date <br /> ��11� �►WK� <br />