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. <br /> t ��� I <br /> � � - AUTONIATIC'FIRE'SPRINKLER PERMITS <br /> � . _ _.:;��.� . . <br /> , . .� . <br /> ,4 !/lo�� <br /> :Please`Clieck;-0ne:_ : _ � - ���7'" b7 <br /> ❑ New ❑ Addition [. Remodel ❑ Replace <br /> ��Job Site/Owner Inforniation: �: � ��2�"`"_V ��� , <br /> a � <br /> Site Address: 0�7� ��C�QQ-r� ��,(�ly� ° <br /> � � � �— —� v <br /> Owner: �r�� �� Mailinb Address: <br /> City: Zip: <br /> H�me Phone� Altemate Pho�e: <br /> Contractor/Appl'rcant Inforniation: <br /> Contractor/App.:L:�j��,�, ��-� ��,;-F- Contact Person: �,,�,.��-����� <br /> Address: �� t L.�, ��Li„ �-,'f 1/r. �• State License #: �; z �-_, <br /> City: y�,'�,p�, Zip: "—�,� Expiration Date: ��.�c����T__ <br /> i <br /> Phone: � t;�- �J�I -�i 1 I I Alternate Phone: � �,� .-�� - y 7i,� <br /> ---- <br /> TYPES OF FTRE SPRL\'KLER PERIYIITS : <br /> �. Corrunercial—Fire Sprinkler ❑ Residential—Fire Sprinkler <br /> Fire Systems Peiznit Fire Systems Permit <br /> *Base Price=Contract Price: $ =��X��u� x.0125 =S �j,G� (Minimum$35.00) <br /> *Surcharge=Centract Pric�: $ x.0005 =� _=,�v (�Tinimum � .5Q) <br /> *Mail-In Fee(Only On Mail In Applications) _� 1.50 <br /> *Total Cost of Permit: _$ ?J7, O� <br /> The undersigned herby applies to tbe City for issuance of a Sprinkler Systems Pernut. Applicant agrees <br /> that a11 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 /> �y.�� . _�,'��.z: `- ��1� � <br /> Applicant Date <br /> -- Reset Form ' /���v'uv �c� rl��/c� � <br /> _ _ <br /> `?� �� <br />