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. ' AUTOMATIC FII2E SPRINKLER PER�ITS <br /> Pl�ase Check One: -� � <br /> ❑ New ❑ Addition [� Remodel ❑ Replace <br /> Job Site i Owner Inf�at:matic�n: - �� � <br /> Site Adciress: ,-x `�I 1 �i `� p l'�'� ; � 'e (,U�� � <br /> Owner: �� � ' �J �t,�C, ��c��� Mailing Address: 2 y 7�� �0���1!��� [.��.�;,.�L <br /> City: �,�U�i�' Zip: �S�s� <br /> Home Phone: 1�-�1 �� Z��' � �7 F: ��' Alternate Phone: <br /> Contractor 1 Applicant Infarmation: <br /> r , <br /> Contractor/App.: � ���r 5�����` f'' � �`�`�����Contact Person: ���G�1 S� �E'� <br /> � <br /> Address: 7S� d �"�y7��� ��G�- State License #: C �O <br /> City: ��O�G� •� Lip: �S��f� � Expiration Date: � f� <br /> Phone: �� 2� - `� �l C� � �7`� 3 o Altemate Phone: �� ��— y J L - Z 7 7 7 <br /> ' TYPES UF FIRE SFRIt`�iKiJEK PERM�TS ' <br /> � i�ommercial-Fire Sprinkler �Residential-Fire Sprinkler <br /> F'ire Systems Pennit H ire Systems Permit <br /> * Base Price=Contract Price: $ � > G x.0125 =$ —4 � ' (Minimum$50.00) <br /> L/,.-, h 3 <br /> *Surcharge=Contract Price: $ /) � x.0005 =$ V• � <br /> * Mail-In Fec(Onl��On Mail In Applications) _$ 2.00 <br /> *'Total Cost of Permit: _$ <br /> Sz` <br /> The un�lersigued herby applies to the City tor issuance of n Sprinkler SysCems Pertnit Applicant agrees <br /> that all systems shall be dcsigncd, 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 certif7es that all statemcnts made on this <br /> applicatio are complete, truc and correct. <br /> G�-��/_��-� <br /> Appl ica Date <br />