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� ! � <br /> i , <br /> ab � �� o0 9sl <br /> �-zs-� y <br /> AUTo�Tic�ZR.E sruttv�E�. ���s <br /> Please Check One: � <br /> D f e�/1��/R/ �-l <br /> �,- /Z T f�u� �,ni�9t <br /> ❑ New ❑ Addition [� Remodel ❑ Replace �P� �� <br /> `��c�L�,�'��'�"�ri:� :�i �i�a: �f�z s <br /> a <br /> Site Address: _�'`7��Z (� �[�n t,�.'t�L�(�`c�,�=C.�' <br /> Owner: �1�t��t/17' /�i `i"119�kv�l1 1(..�1�'�('�l Mailing Address: ���'1�'.J <br /> City: �,E'c''�t�"�� zip: a 5�,�j/ <br /> Ho��e Phone: Altemate Phone: <br /> � Contractor(Applicant I�formation: <br /> — ___ Se�n �61 Z) q9o-7530 <br /> Contractor/App.�-� ��`��c.i:�j-, /Lt i��:c�"' Contact Person: <br /> Address: ?5L�(`✓ t,�r�>ZA G�t ,����'��`� State License#: �'t�� �� <br /> City: C'.�c�C.�tn(�+/��{� Zip: SS5'Z�7 Expiration Date: �; -Zc'� �il� <br /> Phone: �Gi3 'Y7.3 �' �%G�/�(_i Alternate Phone: �7a� Z•�`�-��>Co�1�' <br /> ,"�`'� ` = T�FES O�`���=�P�II�[l��t FERMI'TS `' � , ,`"••, <br /> ❑ Commercial—Fire Sprinkler ❑ Residential—Fire Sprinkler <br /> Fire Systems Permit Fire Systems Permit <br /> � <br /> *Base Price=Contract Price:$ � x A125 =$ S� (Minimum$50.00) <br /> *Surchargc=Contract Price:$ z ��� x.0005 =$� <br /> * Mail-In Fee(Only On Mail In Applications) _$ 2.00 <br /> y� <br /> *Total Cost of Permit: _$ .s�""' <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.-?5,Minnesota State <br /> Building Code,Minnesota State Fire Code and Standards,and certifies that all statements made on this <br /> appli ion are compl�,true an�l correct. <br /> ,-c'<« `L!;1-z >t _ = � �/�.. �'f.1f� <br /> Applicant Date <br />