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) r <br /> -�� � - �����.A.VTOMATIC F�.��"�T:�E���'ERl1+�T'.�S ����"��.. � ..� � <br /> �, .; ,r�.��__ ,���...:,,.. . <br /> F� / ��4�..,".�� <br /> �.'', l„ <br /> ` .y . ,.�: , , ., <br /> � � ,� �. , , -�� <br /> [� New ❑ Addition ❑ Remodel ❑ Replace <br /> Job Site 1 Owner Information: ' <br /> Site Address: ��J�Q (��b�c5��� �ou.r'�- <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Cor�traetor 1 Applicant Information: ,,,M' <br /> Contractor/App.: 1,.�.re�r �� ��}u,�ic,� Contact Person: <br /> Address: �-bzx� l„�c..y2G�a �i��c� State License#: Cv�O <br /> City: Go c.�� Zip: 55��-�o Expiration Date: �.�ZUI G� <br /> Phone: L��'��"�"�2-� Alternate Phone: �� Z— 9���g Z� <br /> �,� ,� p ��� �"'�P����;T�"S�'"�����'' ,�..,'��. �'. �'�.����� , <br /> � � � <br /> �. 5-yi�Y"���� � , �._;._ <br /> ❑ Commercial—Fire Sprinkler � Residential—Fire Sprinkler <br /> Fire Systemti Permit Fire Systems Permit <br /> *Base Price=Contract Price: $ '�(�.�x.0125 =$ Jr�,�� (Minimum$50.00) <br /> *Surcharge=Contract Price:$ 3���b�x.0005 =$ ��$3 <br /> *Mail-In Fee(Only On Mail In Applications) _$ 2.00 <br /> *Total Cost of Permit: —$ 5� 83 <br /> The undersigned herby applies to the City for issuance of a Sprinkler Systems Permit. Applicant igrees <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 r com ete,true and correct. <br /> ZZ Z G�S <br /> Applicant Date <br />