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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: ,2735 �D���. �v�n 'T-i��L � <br /> Owner: �'1.�.�• ��S Mailing Address: <br /> city: ��� �•v� , N� zip: SS33 0 <br /> Home Phone: 7�i 3—?�3��� SO Alternate Phone: <br /> Contractor/Applicant Information: <br /> Contractor/App.: �QuPA CY1�c�. Contact Person: �ftF}D �uzt?�'Pr <br /> Address: I�1$b-►4"1�� C-r � .� . State License #: '►c Ly'� �3� <br /> City: C ttl ���1 tc.G Zip: S5'33� Expiration Date: � 2'3� - � � <br /> Phone: 7 4�"�`��'s3 k 0 Alternate Phone: <br /> TYPES OF FIRE SPRINKL�R PERMITS <br /> ❑ Commercial—Fire Sprinkler [17�Residential—Fire Sprinkler <br /> Fire Systems Permit Fire Systems Permit <br /> * Base Price=Contract Price: $ ��� �n��oo x.0125 =$ /.S'd. 00 (Minimum$50.00) <br /> * Surcharge=Contract Price: $ �2� obD,00 x.0005 =$ CP,da <br /> * Mail-In Fee(Only On Mail In Applications) _$ .�'00 <br /> * Total Cost of Permit: _$ �Jr�o. �a <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 S ire Code and Standards, and certifies that all statements made on this <br /> appl' a o ete, tr nd correct. <br /> q- il - �s <br /> Applicant Date <br />