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AUTOMATIC FIRE SPRINKLER PERMITS <br /> Please Check One: ' <br /> � New ❑ Addition ❑ Remodel ❑ Replace <br /> Job Site/Owner Information: <br /> Site Address: ��V1,11V 6�K!�IIOV� �` ! �j U �' ��������� ��-- '1 <br /> � � y � �i ll ( ( <br /> Owner: '� - � � Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor/Applicant Information: � <br /> Contractor/App.: L,. .�,Pyk�v�'F�� �l�� � Contact Person: �S- .� <br /> Address: f�7�T'/ �� 7 �� �d � ��� State License #: ��' --G ��' <br /> `� j'/ Vil�� 5 � L1�( 7 _�; �-'� <br /> City: � � G�-�ct.//1—Zip: Expiration Date: _.l (.��C �� � <br /> Phone: � � Z� •� �7�� ' ������� Alternate Phone: <br /> TYPES OF FIRE SPRINKLER PERIVIITS <br /> ❑ Commercial—Fire Sprinkler ❑ Residential—Fire Sprinkler <br /> Fire Systems Permit Pire Systems Permit <br /> *Base Price=Contract Price: $��� x .0125 =$ (Minimum�35.00) <br /> * Surcharge=Contract Price: $ x .0005 =$ (Minimum $ .50) <br /> * Mail-In Fee(Only On Mail In Applications) =S 1.50 <br /> *Total Cost of Permit: _$ �- �v <br /> ��7� -��o � ,� i ,�� ,�� �iS ,���-�� <br /> The undersigned herby applies to the City for issuance of a Sprinkler Systems Permit. Applicant agrees <br /> tbat 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 /> �� ,`� ���� ��-�-� � <br /> Applicant Date <br /> Reset Form <br /> . /� -����-- �, <br /> � <br />