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S � <br /> AUTOMATIC FIRE SPRINKLER PERMITS <br /> Please Check One: <br /> ❑ New 0 Addition ❑ Remodel ❑ Replace <br /> Job Site/Owner Information: <br /> nV <br /> �� 50 Kelley Parkway <br /> Site Address: <br /> Orono Police Department 2750 Kelley Parkway <br /> Owner: Mailing Address: <br /> Orono 55356 <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor/Applicant Information: <br /> Summit Companies Amanda Gerboth <br /> Contractor/App.: Contact Person: <br /> 575 Minnehaha Ave W C-075 <br /> Address: State License#: <br /> St. Paul 55103 <br /> City: Zip: Expiration Date: <br /> 651.251.1880 651.288.0760 <br /> Phone: Alternate Phone: <br /> TYPES OF FIRE SPRINKLER PERMITS <br /> ❑✓ Commercial—Fire Sprinkler ❑ Residential—Fire Sprinkler <br /> Fire Systems Pennit Fire Systems Permit <br /> 28,850.00 360.63 <br /> *Base Price=Contract Price: $ x.0125 =$ (Minimum$50.00) <br /> 28,850.00 14.43 <br /> * Surcharge=Contract Price: $ x.0005 =$ <br /> *Mail-In Fee(Only On Mail In Applications) _$ 2.00 <br /> *Total Cost of Permit: _� <br /> 377.06 <br /> The undersigned herby applies to the City for issuance of a Sprinkler Systeins Permit. Applicant agrees <br /> that all s stems shall be designed,installed and maintained to N.F.P.A.-13,N.F.P.A.-25, Minnesota State <br /> Bu' mg ode,Minne ta S e Fi Code tandards, and certifies that all stateinents inade on this <br /> a lic �o are comp t ,t e and orrec . <br /> , <br /> 9/19/2014 <br /> ' ant Date <br />