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� � � � AUTOIVIATIC FIRE SYR�N�KLER PERMITS � <br /> � �o-D <br /> � 3 <br /> Please Check One: _� �� ��� <br /> � New ❑ Addition ❑ Remodel ❑ Rcplace <br /> Job Site/Owner Information: <br /> Site Address: ��� � 1�o ��'�-� S P'� � '`� � ,Z p . <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alteniate Phone: <br /> Contractor/Applicant Informatiom, <br /> Contractor/App.: S��"riw �f R-� P�IZ'�-►►�o�ontact Person: �'�N� �J i�--�3��tZ-- <br /> �y3q H�Y � i s�.v <br /> Address: �'c� ►3�k f.�`i State License#: L -C U � <br /> City: i�iAv►i.�:-;� Zip: �s3g n Expiration Date: �% •- 3� -- � �`i <br /> Phone: 7 4 3 � %s�3 - Y'-r�. 3 Alteniate Phone: (�j Z - �T Ir�-l�•�3� <br /> TYPES OF FIRE SPRINKLER PERMIT5 <br /> ❑ Corrnnercial-Fire Sprinkler � Residential-Fire Sprinkler <br /> Fire Systems Pei�nit Fue Sy;tems Permit <br /> e � <br /> *Base Price=Contract Price: $ � (,.[►ca x A125 =� ,��G7 `� (Minimum$35.00) <br /> v <br /> * Surcharge=Contract Pricc: $ (v�� z .0005 =$ �� � (Minimum $ .50) <br /> * Mail-In Fee(Only On Mail In Applications) _$ 1.50 <br /> 3 `' <br /> *Total Cost of Permit: _$ �(�� �f <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 coirect. <br /> � {� � -`! -� C� <br /> Ap icant Date <br /> ,...,_,. . <br /> r.... .. .. . <br /> �Reset Form <br /> . <br /> �p P �n ��c/ ��/6 � 8 7�..�.¢.! j��� <br />