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. <br /> EIUTOMATIC FIRE�FKINKLER PERMITS <br /> ��t? � �� !� ;�t�`� �� ��• �� .,:_:-vf <br /> l % <br /> PIeaS��'����� ,� `f � � <br /> �] New ❑ Addition ❑ Remodel ❑ Replace <br /> Backflow Device: ❑ nVB ❑ PVE3 <br /> Job Site l Qwner In�oemation: � <br /> ,�. "� - <br /> ��^� �' ( ,T'-". � �7 3 ��...__ 1 \��1�` ���� <br /> ; � � I ' r yt � �. �. 1 <br /> Site Address: ���-����� � �__-Y J��__��'f�°.1 �,._ �-� �--- , _.K <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> � Con� traetar I�1pp(icant Information°'�� , <br /> � r <br /> Contractor/^ ��-�Contact Person: ���`�� ��� <br /> ,��/`�� � � �� <br /> Y � " �!,��1�ate License #: � <br /> �. � � . .�., `� `_, .;`� <br /> � . <br /> ���/� �� � Expiration Date: ���-� �� �1�� <br /> � �i► ' '� _ ,- , -] <br /> � �' � Alternate Phone: �f'`��-� ����, - ,'�,��I J•� <br /> L <br /> � d � �__-____ __ _- -- ___---, <br /> � �,(�� � � t[�KLFR PEI2MITS �� �� � � � ���� � <br /> �,�,� ��5 � - - <br /> �, ''� ��J I� � � � ,�� !�,. � Residential-Fire Sprinkler <br /> � � <br /> � /�{��r'.i✓ �� I�ire Systems Pcrmit <br /> Vv <br /> _ .,.u125 =$ y j .�`� (Minimu $50.00 <br /> ...e: $� ���_ x.0005 =$ 1.`�tS 3 <br /> _..-in Fee (Only On Mail In Applications) _$ -�&A-N�� <br /> c- � � ' <br /> * Total Cost of Permit: _$ ��� ,�J <br /> The undersigned herby applies to the C ity 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 State Fire Code and Standards, and certifies that all statements made on this <br /> application are complete, true and correct. <br /> � � t�''� �' ���i�f_r . � � -��.��/�_��, <br /> Applicant Date <br /> L_. <br />